Heart rate variability and psychosocial symptoms in adolescents and young adults with cancer.

Mallory R Taylor,Abby R Rosenberg,Michelle M Garrison,Michael Kaess

doi:10.1371/journal.pone.0259385

Mallory R Taylor, Abby R Rosenberg + Show 2 more

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https://doi.org/10.1371/journal.pone.0259385

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Journal: PloS one	Publication Date: Nov 4, 2021
Citations: 2	License type: CC BY 4.0

Affiliation: Seattle Children's Hospital, University of Washington

Abstract

Heart Rate Variability (HRV) is a valid, scalable biomarker of stress. We aimed to examine associations between HRV and psychosocial outcomes in adolescents and young adults (AYAs) with cancer. This was a secondary analysis of baseline data from a randomized trial testing a resilience intervention in AYAs with cancer. Two widely used HRV metrics, the standard deviation of normal to normal beats (SDNN) and root mean square of successive differences (RMSSD), were derived from electrocardiograms. Patient-reported outcome (PRO) survey measures included quality of life, anxiety, depression, distress, and resilience. Linear regression models were used to test associations between HRV and PRO scores. The Wilcoxon rank sum test was used to test differences in median HRV values among participant subgroups. Among the n = 76 patients with available electrocardiograms, the mean age was 16 years (SD 3y), 63% were white, and leukemia/lymphoma was the most common diagnosis. Compared to healthy adolescents, AYAs with cancer had lower median HRV (SDNN [Females: 31.9 (12.8-50.7) vs 66.4 (46.0-86.8), p<0.01; Males: 29.9 (11.5-47.9) vs 63.2 (48.4-84.6), p<0.01]; RMSSD [Females: 28.2 (11.1-45.5) vs 69.0 (49.1-99.6), p<0.01; Males: 27.9 (8.6-48.6) vs 58.7 (44.8-88.2), p<0.01]). There was no statistically significant association between PRO measures and SDNN or RMSSD in either an unadjusted or adjusted linear regression models. In this secondary analysis, we did not find an association between HRV and psychosocial PROs among AYAs with cancer. HRV measures were lower than for healthy adolescents. Larger prospective studies in AYA biopsychosocial research are needed.

Highlights

Psychological distress is prevalent during adolescent development, and adolescents and young adults (AYAs) with serious illness like cancer experience even higher rates of depression, posttraumatic stress, and suicide [1,2,3]
It is not surprising that reduced Heart Rate Variability (HRV) has been documented in the leukemia population [24] and adult survivors of childhood cancers [25]
The implications for reduced HRV in AYA oncology patients compared to healthy adolescents warrants further investigation

Summary

Introduction

Psychological distress is prevalent during adolescent development, and adolescents and young adults (AYAs) with serious illness like cancer experience even higher rates of depression, posttraumatic stress, and suicide [1,2,3]. Positive psychological well-being has been associated with protective effects, including lower risk of relapse and cancer-related mortality [7]. Activation of the parasympathetic and sympathetic branches of the ANS has been associated with symptoms of anxiety, depression, and fatigue in patients with cancer [9, 10]. Interruption of sympathetic adrenergic signaling using β-blocker medications is associated with improved metastatic and inflammatory biomarkers, as well as lower cancer-specific mortality in patients with breast cancer [11,12,13]. We aimed to examine associations between HRV and psychosocial outcomes in adolescents and young adults (AYAs) with cancer

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