School of Clinical Medicine, University College London Medical School, Gower Street, London, WC1E 6BT, UK.
Division of Cardiovascular Medicine, Brigham and Women's Hospital Heart and Vascular Center/Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
Curr Cardiol Rep. 2018 Jul 3;20(8):69. doi: 10.1007/s11886-018-1010-y.
Elucidating the mechanisms that contribute to adverse cardiovascular (CV) outcomes and reduce quality of life among patients with cancer is paramount. Cancer, certain cancer drugs, radiation therapy, cancer-associated lifestyle disturbances, and cancer-independent comorbidities combine to predispose oncology patients to autonomic dysfunction (AD). This review will explore the assessment, etiology, and clinical implications of AD in cancer patients and will speculate on therapeutic and research opportunities.
AD is particularly prevalent among patients with advanced cancer, but studies suggest increased prevalence across the entire continuum of cancer survivors compared to cancer-free controls. Data on cancer therapy-induced injury to the autonomic nervous system are limited to small studies. AD has been reported after cranial, neck, and mediastinal radiation therapy. Although AD has been shown to confer increased risk of adverse CV outcomes in cancer-free patients, the prognostic relevance of AD in oncology patients is less well investigated. Markers of AD including elevated resting heart rate (HR), reduced HR variability, and abnormal HR recovery have been associated with shorter survival times in various cancer cohorts. Furthermore, AD has been implicated in the etiology of cancer-related fatigue and exercise limitation. Multiple risk factors predispose oncology patients to AD, which is associated with adverse outcomes, including increased mortality, exercise limitation, and fatigue among this cohort. The contribution of AD to overall morbidity and mortality in cancer survivors has largely been overlooked to date. Further investigation is necessary to better understand cancer-treatment specific autonomic injury and to evaluate the role of various pharmacological and non-pharmacological interventions with potential to tackle the sympathovagal imbalance observed in cancer survivors.
阐明导致癌症患者心血管不良结局和生活质量下降的机制至关重要。癌症、某些癌症药物、放射治疗、与癌症相关的生活方式紊乱以及与癌症无关的合并症使肿瘤患者易发生自主神经功能障碍（AD）。本综述将探讨癌症患者 AD 的评估、病因学和临床意义，并推测治疗和研究机会。
AD 在晚期癌症患者中尤为常见，但研究表明，与无癌症对照组相比，整个癌症幸存者群体中 AD 的患病率都有所增加。关于癌症治疗引起的自主神经系统损伤的数据仅限于小型研究。AD 已在颅、颈部和纵隔放射治疗后报道。尽管 AD 已被证明在无癌症患者中增加了不良心血管结局的风险，但 AD 在肿瘤患者中的预后相关性研究较少。AD 的标志物，包括静息心率（HR）升高、HR 变异性降低和 HR 恢复异常，与各种癌症队列的生存时间缩短有关。此外，AD 与癌症相关疲劳和运动受限的病因有关。多种危险因素使肿瘤患者易发生 AD，AD 与不良结局相关，包括该患者群体的死亡率增加、运动受限和疲劳。AD 对癌症幸存者总发病率和死亡率的影响在很大程度上尚未得到重视。需要进一步研究以更好地了解癌症治疗特异性自主神经损伤，并评估各种具有潜在治疗作用的药理学和非药理学干预措施的作用，这些干预措施可能有助于解决癌症幸存者中观察到的交感神经-副交感神经失衡。
