Play all audios:
ABSTRACT Healthy cardiac autonomic functioning (CAF) is essential for maintaining homeostasis in response to the environmental demands of everyday life. Impaired CAF is associated with
higher morbidity and higher mortality. To explore CAF in survivors of allogeneic hematopoietic stem cell transplantation (allo-HSCT) 1–10 years after transplant (median=4.3 years), an
ambulatory assessment was performed with 104 patients, and 45 age- and gender-matched healthy controls. Heart rate (HR) and respiratory sinus arrhythmia (RSA, that is, high-frequency HR
variability) were measured in a laboratory setting and during a 12-hour naturalistic period of daily life. Cancer-related fatigue was assessed by the Functional Assessment of Chronic Illness
- Fatigue questionnaire; physical fitness by bicycle-ergometry VO2max. In contrast to healthy controls, 4-year post-HSCT fatigue was greater in patients (_P_<0.0001, Cohen’s _d_ effect
size [_d_]=1.14), and fitness was lower in patients (_P_<0.0001, _d_=1.09). In both laboratory and real-life ambulatory conditions, average HR was persistently higher (_P_<0.0001,
_d_=0.88) and mean RSA magnitude lower (_P_<0.001, _d_=0.69) among patients, compared with controls. Severely fatigued patients showed higher HR and lower parasympathetic cardiac control
than non-fatigued patients (HR: _P_=0.02, _d_=0.47; RSA: _P_=0.02, _d_=0.72), and this was unrelated to fitness. These findings may have important implications for predicting long-term
treatment outcome and consequences for routine post-HSCT care. Access through your institution Buy or subscribe This is a preview of subscription content, access via your institution ACCESS
OPTIONS Access through your institution Subscribe to this journal Receive 12 print issues and online access $259.00 per year only $21.58 per issue Learn more Buy this article * Purchase on
SpringerLink * Instant access to full article PDF Buy now Prices may be subject to local taxes which are calculated during checkout ADDITIONAL ACCESS OPTIONS: * Log in * Learn about
institutional subscriptions * Read our FAQs * Contact customer support SIMILAR CONTENT BEING VIEWED BY OTHERS REDUCED PREFRONTAL CORTEX AND SYMPATHETIC NERVOUS SYSTEM ACTIVITY CORRELATE WITH
FATIGUE AFTER AHSCT Article Open access 04 December 2021 REDUCED CARDIOVASCULAR RESERVE CAPACITY IN LONG-TERM ALLOGENEIC STEM CELL TRANSPLANT SURVIVORS Article Open access 06 February 2023
MHEALTH SYSTEM (ATOPE+) TO SUPPORT EXERCISE PRESCRIPTION IN BREAST CANCER SURVIVORS: A RELIABILITY AND VALIDITY, CROSS-SECTIONAL OBSERVATIONAL STUDY (ATOPE STUDY) Article Open access 08
September 2022 REFERENCES * Horan JT, Logan BR, Agovi-Johnson MA, Lazarus HM, Bacigalupo AA, Ballen KK _et al_. Reducing the risk for transplantation-related mortality after allogeneic
hematopoietic cell transplantation: how much progress has been made? _J Clin Oncol_ 2011; 29: 805–813. Article Google Scholar * Tichelli A, Socie G . Considerations for adult cancer
survivors. _Hematology Am Soc Hematol Educ Program_ 2005: 516–522. * Tichelli A, Bhatia S, Socie G . Cardiac and cardiovascular consequences after haematopoietic stem cell transplantation.
_Br J Haematol_ 2008; 142: 11–26. Article Google Scholar * Tichelli A, Passweg J, Wojcik D, Rovo A, Harousseau JL, Masszi T _et al_. Late cardiovascular events after allogeneic
hematopoietic stem cell transplantation: a retrospective multicenter study of the Late Effects Working Party of the European Group for Blood and Marrow Transplantation. _Haematologica_ 2008;
93: 1203–1210. Article Google Scholar * Fagundes CP, Murray DM, Hwang BS, Gouin JP, Thayer JF, Sollers JJ 3rd _et al_. Sympathetic and parasympathetic activity in cancer-related fatigue:
more evidence for a physiological substrate in cancer survivors. _Psychoneuroendocrinology_ 2011; 36: 1137–1147. Article Google Scholar * Crosswell AD, Lockwood KG, Ganz PA, Bower JE . Low
heart rate variability and cancer-related fatigue in breast cancer survivors. _Psychoneuroendocrinology_ 2014; 45: 58–66. Article Google Scholar * Giese-Davis J, Wilhelm FH, Conrad A,
Abercrombie HC, Sephton S, Yutsis M _et al_. Depression and stress reactivity in metastatic breast cancer. _Psychosom Med_ 2006; 68: 675–683. Article Google Scholar * Prieto JM, Atala J,
Blanch J, Carreras E, Rovira M, Cirera E _et al_. Role of depression as a predictor of mortality among cancer patients after stem-cell transplantation. _J Clin Oncol_ 2005; 23: 6063–6071.
Article Google Scholar * Loberiza FR Jr, Rizzo JD, Bredeson CN, Antin JH, Horowitz MM, Weeks JC _et al_. Association of depressive syndrome and early deaths among patients after stem-cell
transplantation for malignant diseases. _J Clin Oncol_ 2002; 20: 2118–2126. Article Google Scholar * Giese-Davis J, Collie K, Rancourt KM, Neri E, Kraemer HC, Spiegel D . Decrease in
depression symptoms is associated with longer survival in patients with metastatic breast cancer: a secondary analysis. _J Clin Oncol_ 2011; 29: 413–420. Article Google Scholar * Adams MJ,
Lipsitz SR, Colan SD, Tarbell NJ, Treves ST, Diller L _et al_. Cardiovascular status in long-term survivors of Hodgkin's disease treated with chest radiotherapy. _J Clin Oncol_ 2004;
22: 3139–3148. Article Google Scholar * Viniegra M, Marchetti M, Losso M, Navigante A, Litovska S, Senderowicz A _et al_. Cardiovascular autonomic function in anthracycline-treated breast
cancer patients. _Cancer Chemother Pharmacol_ 1990; 26: 227–231. Article CAS Google Scholar * Postma A, Bink-Boelkens MT, Beaufort-Krol GC, Kengen RA, Elzenga NJ, Schasfoort-van Leeuwen
MJ _et al_. Late cardiotoxicity after treatment for a malignant bone tumor. _Med Pediatr Oncol_ 1996; 26: 230–237. Article CAS Google Scholar * Postma A, Elzenga NJ, Haaksma J,
Schasfoort-Van Leeuwen MJ, Kamps WA, Bink-Boelkens MT . Cardiac status in bone tumor survivors up to nearly 19 years after treatment with doxorubicin: a longitudinal study. _Med Pediatr
Oncol_ 2002; 39: 86–92. Article CAS Google Scholar * Brouwer CAJ, Gietema JA, van den Berg MP, Bink-Boelkens MTE, Elzenga NJ, Haaksma J _et al_. Long-term cardiac follow-up in survivors
of a malignant bone tumour. _Ann Oncol_ 2006; 17: 1586–1591. Article CAS Google Scholar * Grossman P, Deuring G, Garland SN, Campbell TS, Carlson LE . Patterns of objective physical
functioning and perception of mood and fatigue in posttreatment breast cancer patients and healthy controls: an ambulatory psychophysiological investigation. _Psychosom Med_ 2008; 70:
819–828. Article Google Scholar * Walsh D, Nelson KA . Autonomic nervous system dysfunction in advanced cancer. _Support Care Cancer_ 2002; 10: 523–528. Article Google Scholar * Martin
R, Delgado JM, Molto JM, Vicent JM, Manzanares R, Insa R _et al_. Cardiovascular reflexes in patients with malignant disease. _Ital J Neurol Sci_ 1992; 13: 125–129. Article CAS Google
Scholar * Bruera E, Chadwick S, Fox R, Hanson J, MacDonald N . Study of cardiovascular autonomic insufficiency in advanced cancer patients. _Cancer Treat Rep_ 1986; 70: 1383–1387. CAS
PubMed Google Scholar * Fadul N, Strasser F, Palmer JL, Yusuf SW, Guo Y, Li Z _et al_. The association between autonomic dysfunction and survival in male patients with advanced cancer: a
preliminary report. _J Pain Symptom Manage_ 2010; 39: 283–290. Article Google Scholar * Bower JE, Bak K, Berger A, Breitbart W, Escalante CP, Ganz PA _et al_. Screening, assessment, and
management of fatigue in adult survivors of cancer: an American Society of Clinical oncology clinical practice guideline adaptation. _J Clin Oncol_ 2014; 32: 1840–1850. Article Google
Scholar * Bower JE, Ganz PA, Desmond KA, Bernaards C, Rowland JH, Meyerowitz BE _et al_. Fatigue in long-term breast carcinoma survivors: a longitudinal investigation. _Cancer_ 2006; 106:
751–758. Article Google Scholar * Lawrence DP, Kupelnick B, Miller K, Devine D, Lau J . Evidence report on the occurrence, assessment, and treatment of fatigue in cancer patients. _J Natl
Cancer Inst Monogr_ 2004; 32: 40–50. Article Google Scholar * Jager A, Sleijfer S, van der Rijt CC . The pathogenesis of cancer related fatigue: could increased activity of
pro-inflammatory cytokines be the common denominator? _Eur J Cancer_ 2008; 44: 175–181. Article CAS Google Scholar * Ryan JL, Carroll JK, Ryan EP, Mustian KM, Fiscella K, Morrow GR .
Mechanisms of cancer-related fatigue. _Oncologist_ 2007; 12: 22–34. Article CAS Google Scholar * Reuter K, Classen CC, Roscoe JA, Morrow GR, Kirshner JJ, Rosenbluth R _et al_. Association
of coping style, pain, age and depression with fatigue in women with primary breast cancer. _Psychooncology_ 2006; 15: 772–779. Article Google Scholar * Ganz PA, Bower JE . Cancer related
fatigue: a focus on breast cancer and Hodgkin's disease survivors. _Acta Oncol_ 2007; 46: 474–479. Article Google Scholar * Jones DE, Hollingsworth KG, Taylor R, Blamire AM, Newton
JL . Abnormalities in pH handling by peripheral muscle and potential regulation by the autonomic nervous system in chronic fatigue syndrome. _J Intern Med_ 2010; 267: 394–401. Article CAS
Google Scholar * Hoad A, Spickett G, Elliott J, Newton J . Postural orthostatic tachycardia syndrome is an under-recognized condition in chronic fatigue syndrome. _Qjm_ 2008; 101: 961–965.
Article CAS Google Scholar * Newton JL, Okonkwo O, Sutcliffe K, Seth A, Shin J, Jones DE . Symptoms of autonomic dysfunction in chronic fatigue syndrome. _Qjm_ 2007; 100: 519–526. Article
CAS Google Scholar * Grossman P, Wilhelm FH, Spoerle M . Respiratory sinus arrhythmia, cardiac vagal control, and daily activity. _Am J Physiol Heart Circ Physiol_ 2004; 287: H728–H734.
Article CAS Google Scholar * Grossman P, van Beek J, Wientjes C . A comparison of three quantification methods for estimation of respiratory sinus arrhythmia. _Psychophysiology_ 1990; 27:
702–714. Article CAS Google Scholar * Buchheit M, Gindre C . Cardiac parasympathetic regulation: respective associations with cardiorespiratory fitness and training load. _Am J Physiol
Heart Circ Physiol_ 2006; 291: H451–H458. Article CAS Google Scholar * De Meersman RE . Heart rate variability and aerobic fitness. _Am Heart J_ 1993; 125: 726–731. Article CAS Google
Scholar * Filipovich AH, Weisdorf D, Pavletic S, Socie G, Wingard JR, Lee SJ _et al_. National Institutes of Health consensus development project on criteria for clinical trials in chronic
graft-versus-host disease: I. Diagnosis and staging working group report. _Biol Blood Marrow Transplant_ 2005; 11: 945–956. Article Google Scholar * Yellen SB, Cella DF, Webster K,
Blendowski C, Kaplan E . Measuring fatigue and other anemia-related symptoms with the Functional Assessment of Cancer Therapy (FACT) measurement system. _J Pain Symptom Manage_ 1997; 13:
63–74. Article CAS Google Scholar * Astrand PO, Ryhming I . A nomogram for calculation of aerobic capacity (physical fitness) from pulse rate during sub-maximal work. _J Appl Physiol_
1954; 7: 218–221. Article CAS Google Scholar * Thorsen L, Skovlund E, Stromme SB, Hornslien K, Dahl AA, Fossa SD . Effectiveness of physical activity on cardiorespiratory fitness and
health-related quality of life in young and middle-aged cancer patients shortly after chemotherapy. _J Clin Oncol_ 2005; 23: 2378–2388. Article Google Scholar * Grossman P . The LifeShirt:
a multi-function ambulatory system monitoring health, disease, and medical intervention in the real world. _Stud Health Technol Inform_ 2004; 108: 133–141. PubMed Google Scholar * Wilhelm
FH, Roth WT, Sackner MA . The lifeShirt. An advanced system for ambulatory measurement of respiratory and cardiac function. _Behav Modif_ 2003; 27: 671–691. Article Google Scholar *
Walters JA, Wood-Baker R, Walls J, Johns DP . Stability of the EasyOne ultrasonic spirometer for use in general practice. _Respirology_ 2006; 11: 306–310. Article Google Scholar * Skloot
GS, Edwards NT, Enright PL . Four-year calibration stability of the EasyOne portable spirometer. _Respir Care_ 2010; 55: 873–877. PubMed Google Scholar * Grossman P, Karemaker J, Wieling W
. Prediction of tonic parasympathetic cardiac control using respiratory sinus arrhythmia: the need for respiratory control. _Psychophysiology_ 1991; 28: 201–216. Article CAS Google
Scholar * Grossman P, Kollai M . Respiratory sinus arrhythmia, cardiac vagal tone, and respiration: within- and between-individual relations. _Psychophysiology_ 1993; 30: 486–495. Article
CAS Google Scholar * Mann HB, Whitney DR . On a test of whether one of two random variables is stochastically larger than the other. _Ann Math Stat_ 1947; 18: 50–60. Article Google
Scholar * Schiff D, Wen PY, van den Bent MJ . Neurological adverse effects caused by cytotoxic and targeted therapies. _Nat Rev Clin Oncol_ 2009; 6: 596–603. Article Google Scholar *
Verstappen CC, Heimans JJ, Hoekman K, Postma TJ . Neurotoxic complications of chemotherapy in patients with cancer: clinical signs and optimal management. _Drugs_ 2003; 63: 1549–1563.
Article CAS Google Scholar * Sioka C, Kyritsis AP . Central and peripheral nervous system toxicity of common chemotherapeutic agents. _Cancer Chemother Pharmacol_ 2009; 63: 761–767.
Article CAS Google Scholar Download references ACKNOWLEDGEMENTS We thank the Swiss Cancer League for funding this study (grant no.: KLS-02038-02-2007). Special thanks to the nurses and
physicians of the Zellersatzambulatorium of the Hematology Department of University Hospital Basel for great collaboration and logistical support. Above all, we thank all study participants.
AUTHOR INFORMATION AUTHORS AND AFFILIATIONS * Department of Psychosomatic Medicine, Division of Internal Medicine, University Hospital Basel, Basel, Switzerland G Deuring, A Kiss & P
Grossman * Department of Hematology, Division of Internal Medicine, University Hospital Basel, Basel, Switzerland J P Halter & J R Passweg * Department of Forensic Psychiatry, University
Psychiatric Clinics, Basel, Switzerland G Deuring Authors * G Deuring View author publications You can also search for this author inPubMed Google Scholar * A Kiss View author publications
You can also search for this author inPubMed Google Scholar * J P Halter View author publications You can also search for this author inPubMed Google Scholar * J R Passweg View author
publications You can also search for this author inPubMed Google Scholar * P Grossman View author publications You can also search for this author inPubMed Google Scholar CORRESPONDING
AUTHORS Correspondence to G Deuring or P Grossman. ETHICS DECLARATIONS COMPETING INTERESTS The authors declare no conflict of interest. ADDITIONAL INFORMATION Supplementary Information
accompanies this paper on Bone Marrow Transplantation website SUPPLEMENTARY INFORMATION SUPPLEMENTARY TABLE 1 (DOC 34 KB) SUPPLEMENTARY TABLE 2 (DOC 29 KB) SUPPLEMENTARY TABLE 3 (DOC 31 KB)
RIGHTS AND PERMISSIONS Reprints and permissions ABOUT THIS ARTICLE CITE THIS ARTICLE Deuring, G., Kiss, A., Halter, J. _et al._ Cardiac autonomic functioning is impaired among allogeneic
hematopoietic stem cell transplantation survivors: a controlled study. _Bone Marrow Transplant_ 52, 66–72 (2017). https://doi.org/10.1038/bmt.2016.176 Download citation * Received: 04
January 2016 * Revised: 21 April 2016 * Accepted: 11 May 2016 * Published: 04 July 2016 * Issue Date: January 2017 * DOI: https://doi.org/10.1038/bmt.2016.176 SHARE THIS ARTICLE Anyone you
share the following link with will be able to read this content: Get shareable link Sorry, a shareable link is not currently available for this article. Copy to clipboard Provided by the
Springer Nature SharedIt content-sharing initiative