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Autonomic dysfunction in breast cancer: A systematic review and meta-analysis
Laura Beatriz Pozo-Pérez1, Talia Wegman-Ostrosky2, Natalia Franco3
1Neuro-Oncology Unit, Instituto Nacional de Cancerología, Av. San Fernando 22, Tlalpan, 14080, Mexico City, Mexico.
Background:
Autonomic dysfunction is associated with adverse cardiovascular outcomes, increased symptom burden, and impaired quality of life. Although it is increasingly recognized in patients with breast cancer, its prevalence has not been well established.
Methods:
A systematic review and meta-analysis were conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 recommendations. Databases used were Embase, PubMed/MEDLINE, Scopus, Web of Science, and LILACS (Latin American and Caribbean Health Sciences Literature). Studies were included if they assessed autonomic function in patients with breast cancer and reported or provided sufficient data to estimate the prevalence of autonomic dysfunction, published in English or Spanish from 1954 to February 2026. The quality of the studies was assessed using the Newcastle-Ottawa Quality Assessment Scale and the NIH Quality Assessment Tool.
Results:
A total of 2942 records were identified, of which 58 articles were assessed for eligibility and 6 studies were included in the meta-analysis. Across studies, autonomic function was primarily assessed using cardiovascular autonomic tests, and symptom-based measures. The pooled prevalence of autonomic dysfunction in breast cancer patients was 0.47 (95% CI: 0.33-0.61). Substantial heterogeneity was observed across studies (I2 = 90.8%).
Conclusions:
Autonomic dysfunction affects nearly one in two patients with breast cancer, highlighting dysautonomia as a prevalent, often subclinical, and underrecognized complication with potential implications for cardiovascular health, symptom burden, and quality of life. PROSPERO registration number CRD420251253332.
