Sympathetic and parasympathetic activity in cancer-related fatigue: more evidence for a physiological substrate in cancer survivors

Abstract

Fatigue is a notable clinical problem in cancer survivors, and understanding its pathophysiology is important. This study evaluated relationships between fatigue and both sympathetic and parasympathetic nervous system activity in breast cancer survivors. Norepinephrine and heart rate variability (HRV) were evaluated at rest, as well as during and after a standardized laboratory speech and mental arithmetic stressor. The participants, 109 women who had completed treatment for stage 0-IIIA breast cancer within the past two years, were at least two months post surgery, radiation or chemotherapy, whichever occurred last. Women who reported more fatigue had significantly higher norepinephrine and lower HRV before and after the stressor than their less fatigued counterparts. Fatigue was not related to treatment or disease variables including treatment type, cancer stage, time since diagnosis, and time since treatment. Importantly, the relationship between HRV and cancer-related fatigue was sizeable. Based on research that has demonstrated characteristic age-related HRV decrements, our findings suggest a 20-year difference between fatigued and non-fatigued cancer survivors, raising the possibility that fatigue may signify accelerated aging. Furthermore, lower HRV and elevated norepinephrine have been associated with a number of adverse health outcomes; accordingly, fatigue may also signal the need for increased vigilance to other health threats.

Copyright © 2011 Elsevier Ltd. All rights reserved.

Figures

Fig 1

Mean (± SEM) HRV across experimental periods in fatigued and nonfatigued women based on the 75th and 25th percentile scores on the MFSI-SF. Although fatigued and nonfatigued survivors did not differ in the magnitude of the HRV decrement during the stressor or increment after the stressor, fatigued women had significantly lower HRV at baseline as well as during recovery from the stressor.

Fig 2

Mean (± SEM) norepinephrine across experimental periods in fatigued and nonfatigued women based on the 75th and 25th percentile scores on the MFSI-SF. Although fatigued and nonfatigued survivors did not differ in the magnitude of the norepinephrine increment during the stressor or decrement after the stressor, fatigued women had significantly lower norepinephrine at baseline as well as during recovery from the stressor.