1 Department of Pediatric Hematology and Oncology Unit, University Hospital of Saint-Etienne, Saint-Etienne, France.
2 Childhood Cancer Registry of the Rhône-Alpes Region, University of Saint-Etienne, Saint-Etienne, France.
J Adolesc Young Adult Oncol. 2019 Feb;8(1):9-17. doi: 10.1089/jayao.2018.0021. Epub 2018 Aug 23.
Survival rate of childhood cancers is now reaching 80% overall. However, early or late complications related to surgery, chemotherapy, and radiotherapy remain at a high rate and greatly increase the risk of late mortality. The objective of this study is to assess the autonomic nervous system (ANS) activity, measured through heart rate variability indices in childhood cancer survivors compared with healthy controls.
This prospective study included 51 long-term childhood cancer survivors diagnosed before 15 years of age between 1987 and 1992 and controlled for age and sex with healthy volunteers.
We observed a significant increase in spontaneous heart rate (beats per minute) (67 ± 10 vs. 60 ± 10, p = 0.001), and all the studied parameters showed a significantly altered ANS activity in cases compared with healthy controls. In both groups, the main cofactors of dysautonomia (tobacco, drugs, cannabis, estro-progestative pills, alcohol, limited physical activity) were analyzed without any significant difference. The effect of cancer treatments received was not analyzed due to the small number of participants.
The results showed a significant ANS dysfunction in childhood cancer survivors compared with healthy controls and suggested the value of autonomic screening to underscore and possibly quantify the effect of the cancer treatments in a larger cohort. This evaluation could lead to the recommendation to increase physical activity, the most efficient way known to improve ANS activity, as already shown in other pathologies (breast cancer).
目前儿童癌症的存活率总体上已达到 80%。然而，与手术、化疗和放疗相关的早期或晚期并发症的发生率仍然很高，极大地增加了晚期死亡的风险。本研究的目的是评估儿童癌症幸存者与健康对照组相比自主神经系统（ANS）的活性，通过心率变异性指数来衡量。
这是一项前瞻性研究，纳入了 51 名在 1987 年至 1992 年期间被诊断为 15 岁以下的长期儿童癌症幸存者，并与健康志愿者按年龄和性别进行了匹配。
我们观察到，与健康对照组相比，癌症幸存者的自发心率（每分钟心跳次数）显著增加（67±10 比 60±10，p=0.001），所有研究参数均显示 ANS 活性明显改变。在这两组中，分析了导致自主神经功能紊乱的主要因素（烟草、药物、大麻、雌激素孕激素丸、酒精、身体活动受限），但无显著差异。由于参与者人数较少，未分析癌症治疗的影响。
研究结果表明，与健康对照组相比，儿童癌症幸存者的 ANS 功能明显受损，并提示自主神经筛查的价值，以强调并可能在更大的队列中量化癌症治疗的效果。这种评估可以建议增加身体活动，因为这是已知改善 ANS 活性最有效的方法，在其他疾病（乳腺癌）中已经得到证实。
