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Autonomic nervous system dysfunction in advanced cancer.

Declan Walsh1, Kristine A Nelson

  • 1The Harry R Horvitz Center For Palliative Medicine, The Taussig Cancer Center, The Cleveland Clinic Foundation, 9500 Euclid Ave., M76, Cleveland, Ohio 44195, USA.

Supportive Care in Cancer : Official Journal of the Multinational Association of Supportive Care in Cancer
|September 27, 2002
PubMed
Summary

Autonomic nervous system (ANS) dysfunction is common in advanced cancer patients, affecting all participants in this study. Simple bedside tests revealed significant abnormalities, indicating a need for further research into this paraneoplastic syndrome.

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Area of Science:

  • Neurology
  • Oncology
  • Cardiovascular Physiology

Background:

  • The autonomic nervous system (ANS) regulates involuntary bodily functions and innervates all organs.
  • Autonomic dysfunction has been anecdotally reported in cancer patients, with suggestions of higher prevalence in advanced stages.
  • Existing research often relies on case reports, necessitating broader investigation into autonomic abnormalities in advanced cancer.

Purpose of the Study:

  • To evaluate the prevalence and severity of autonomic nervous system (ANS) dysfunction in patients with advanced cancer.
  • To assess the utility of bedside cardiovascular tests in identifying ANS abnormalities in this population.
  • To explore the relationship between ANS dysfunction and patient-reported symptoms.

Main Methods:

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  • Enrolled 50 inpatients and outpatients with advanced cancer, excluding those with pre-existing conditions or medications affecting the ANS.
  • Utilized five validated bedside cardiovascular tests: heart rate and blood pressure responses to deep breathing, standing, Valsalva maneuver, static exercise, and standing.
  • Scored individual test results and calculated composite dysfunction scores (none, mild, moderate, severe).

    • Main Results:

    • All 50 participants exhibited scores consistent with autonomic nervous system (ANS) dysfunction.
    • 35% of the 245 individual tests performed were normal or borderline.
    • While participants reported a median of 6 symptoms, these did not correlate with the severity of objective ANS test abnormalities.

    Conclusions:

    • Significant autonomic nervous system (ANS) dysfunction is prevalent in advanced cancer patients.
    • Bedside cardiovascular tests can detect ANS abnormalities in this population, though more invasive methods may offer greater precision.
    • Further research employing sophisticated ANS testing is crucial to fully characterize this potential paraneoplastic syndrome.