INFLUENCE OF CANCER SEVERITY AND FUNCTIONAL STATUS OF CANCER ON CARDIAC PARASYMPATHETIC INDICATORS
DOI:
https://doi.org/10.22159/ajpcr.2017.v10i6.18197Keywords:
Cancer, Eastern Cooperative Oncology Group score, Faces pain scale score, Vagal functionAbstract
 Objective: To investigate the influence of cancer severity and functional status of cancer patients on cardiac parasympathetic indicators.
Methods: A total of 267 patients with a fresh clinical diagnosis of solid malignant tumor not yet put on cancer therapy and 250 controls matched for age, sex of study subjects were included. Severity of cancer was defined based on the American Joint Committee on Cancer staging. Accordingly, study subjects were subdivided into early stage (Stage I and II combined) and advanced stage (Stage III and IV combined). In cancer patients, the Eastern Cooperative Oncology Group (ECOG) performance score and the Faces Pain Scale score (FPS) was noted. Two indicators of vagal function, expiratory:inspiratory ratio (E:I ratio) and root mean square of successive N-N interval difference (r-MSSD) were included. E:I ratio during deep breathing at six respiratory cycles/minute and r-MSSD at rest was obtained from 1 minute lead II electrocardiogram. Data were analyzed by applying suitable statistical tests. p≤0.05 was considered significant.
Results: R-MSSD and E:I ratio was significantly reduced in the early and advanced stage of cancer compared to controls (p≤0.0001). r-MSSD and E:I ratio was significantly reduced in advanced stage compared to the early stage of cancer (p≤0.0001). r-MSSD and E:I ratio was significantly different in subgroups of stages of cancer and controls (p≤0.0001). In cancer patients, r-MSSD was negatively correlated with ECOG and FPS score (p≤0.0278, p≤0.0100).
Conclusion: Severity of cancer affects vagal function. However, r-MSSD alone was associated with functional status (ECOG, FPS) of cancer patients.
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References
Malpas SC, Maling TJ. Heart-rate variability and cardiac autonomic function in diabetes. Diabetes 1990;39(10):1177-81.
Pipilis A, Flather M, Ormerod O, Sleight P. Heart rate variability in acute myocardial infarction and its association with infarct site and clinical course. Am J Cardiol 1991;67(13):1137-9.
Gidron Y, Perry H, Glennie M. Does the vagus nerve inform the brain about preclinical tumours and modulate them? Lancet Oncol 2005;6(4):245-8.
De Couck M, Mravec B, Gidron Y. You may need the vagus nerve to understand pathophysiology and to treat diseases. Clin Sci (Lond) 2012;122(7):323-8.
Stone CA, Kenny RA, Nolan B, Lawlor PG. Autonomic dysfunction in patients with advanced cancer; prevalence, clinical correlates and challenges in assessment. BMC Palliat Care 2012;11:3.
Bijoor SN, Subbalakshmi NK, Banerjee S. Cardiac autonomic modulation in cancer patients as assessed by time domain measures of heart rate variability. Int J Health Sci Res 2015;5(2):194-8.
Bijoor SN, Subbalakshmi NK, Banerjee S. Influence of cancer and its severity on vagal nerve activity assessed by time domain measures of heart rate variability. Res J Pharm Biol Chem Sci 2016;7:1215-20.
Sztajzel J. Heart rate variability: A noninvasive electrocardiographic method to measure the autonomic nervous system. Swiss Med Wkly 2004;134(35-36):514-22.
Urooj M, Pillai KK, Monika T, Venkateshan SP, Nilanjan S. Reference ranges for time domain parameters of heart rate variability in Indian population and validation in hypertensive subjects and smokers. Int J Pharm Pharm Sci 2011;3(1):36-9.
Urooj M, Shilpi G, Venkateshan SP, Monika T. Reference range of heart rate variability and validation in subjects with asymptomatic elevated liver function enzymes. Int J Curr Pharm Res 2014;6(4):49-52.
Fouad FM, Tarazi RC, Ferrario CM, Fighaly S, Alicandri C. Assessment of parasympathetic control of heart rate by a non-invasive method. Am J Physiol 1984;246:838-42.
Edge SB, Byrd DR, Compton CC, Fritz Ag, Greene FL, Trotti A, editors. AJCC Cancer Staging Manual. 7th ed. New York: Springer Publishers; 2010.
Warden V, Hurley AC, Volicer L. Development and psychometric evaluation of the pain assessment in advanced dementia (PAINAD) scale. J Am Med Dir Assoc 2003;4:9-15.
Abhishek S, Mubeen K. Biology of head and neck cancer pain. Asian J Pharm Clin Res 2012;5(1):7-9.
Lavigne GJ, Zucconi M, Castronovo V, Manzini C, Veglia F, Smirne S, et al. Heart rate changes during sleep in response to experimental thermal (Nociceptive) stimulations in healthy subjects. Clin Neurophysiol 2001;112:532-5.
Appelhans BM, Luecken LJ. Heart rate variability and pain: Associations of two interrelated homeostatic processes. Biol Psychol 2008;77:174-82.
Oken MM, Creech RH, Tormey DC, Horton J, Davis TE, McFadden ET, et al. Toxicity and response criteria of the Eastern Cooperative Oncology Group. Am J Clin Oncol 1982;5(6):649-55.
Jang RW, Caraiscos VB, Swami N, Banerjee S, Mak E, Kaya E, et al. Simple prognostic model for patients with advanced cancer based on performance status. J Oncol Pract 2014;10:335-9.
Ahmad S, Tejuja A, Newman KD, Zarychanski R, Seely AJ. Clinical review: A review and analysis of heart rate variability and diagnosis and prognosis of infection. Crit Care 2009;13(6):1-7.
Almoznino-Sarafian D, Sarafian G, Zyssman I, Shteinshnaider M, Tzur I, Kaplan BZ, et al. Application of HRV-CD for estimation of life expectancy in various clinical disorders. Eur J Intern Med 2009;20(8):779-83.
Pop-Busui R, Evans GW, Gerstein HC, Fonseca V, Fleg JL, Hoogwerf BJ, et al. Effects of cardiac autonomic dysfunction on mortality risk in the action to control cardiovascular risk in diabetes (ACCORD) trial. Diabetes Care 2010;33(7):1578-84.
Yien HW, Hseu SS, Lee LC, Kuo TB, Lee TY, Chan SH. Spectral analysis of systemic arterial pressure and heart rate signals as a prognostic tool for the prediction of patient outcome in the intensive care unit. Crit Care Med 1997;25(2):258-66.
Physical status: The use and interpretation of anthropometry. Report of a WHO Expert Committee. World Health Organ Tech Rep Ser 1995;854:1-452.
Subbalakshmi NK, Adhikari PM, Sathyanarayana R, Jeganathan PS. Deterioration of cardiac autonomic function over a period of one year in relation to cardiovascular and somatic neuropathy complications in Type 2 diabetes mellitus. Diabetes Res Clin Pract 2012;97:313-21.
Wheeler T, Watkins PJ. Cardiac denervation in diabetes. Br Med J 1973;4:584-6.
Kleiger RE, Stein PK, Bosner MS, Rotman JN. Time domain measurements of heart rate variability. Cardiol Clin 1992;10:487-98.
Minakshi G, Dahiya J, Rakesh KM, Harish D. Therapies in cancer treatment: An overview. Int J Pharm Pharm Sci 2014;7(4):1-9.
Kim K, Chae J, Lee S. The role of heart rate variability in advanced non-small-cell lung cancer patients. J Palliat Care 2015;31(2):103-8.
Herr KA, Mobily PR, Kohout FJ, Wagenaar D. Evaluation of the faces pain scale for use with the elderly. Clin J Pain 1998;14(1):29-38.
Cortelli P, Pierangeli G. Chronic pain autonomic interactions. Neurol Sci 2003;24:68-70.
Heller PH, Perry F, Naifeh K, Gordon NC, Wachter-Shikura N, Levine J. Cardiovascular autonomic response during preoperative stress and postoperative pain. Pain 1984;18:33-40.
Moltner A, Holzl R, Strian F. Heart rate changes as an autonomic component of the pain response. Pain 1990;43:81-9.
Laflamme YT, Rainville P, Marchand S. Establishing a link between heart rate and pain in healthy subjects: A gender effect. J Pain 2005;6:341-7.
Smith SA. Reduced sinus arrhythmia in diabetic autonomic neuropathy: Diagnostic value of an age-related normal range. Br Med J 1982;285:1599-601.
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