# Prognostic and diagnostic utility of heart rate variability to predict and understand change in cancer and chemotherapy related fatigue, pain, and neuropathic symptoms: a systematic review

## TL;DR

This review explores how heart rate variability can help predict and understand fatigue, pain, and neuropathy in cancer patients and survivors.

## Contribution

The study systematically reviews the link between heart rate variability and cancer-related symptoms, highlighting the need for standardized protocols.

## Key findings

- Decreased HRV is associated with increased fatigue and pain in cancer patients.
- There is a need for high-quality studies with standardized HRV protocols in cancer research.
- Most studies focused on breast cancer and predominantly included female participants.

## Abstract

Advances in early cancer detection and treatment have significantly improved survival rates, resulting in over 18.1 million cancer survivors in the USA. Many of these survivors experience chronic pain, fatigue, and neuropathic symptoms related to cancer or its treatments. Emerging evidence suggests that autonomic nervous system dysfunction plays a crucial role in these symptoms. Heart rate variability (HRV), a measure of autonomic function, has shown potential in predicting the onset and progression of these cancer-related symptoms. This systematic review aimed to assess the association of HRV with pain, fatigue, and neuropathy in cancer patients and survivors.

A comprehensive search was conducted across multiple databases, yielding 23 studies that met inclusion criteria. These studies varied in cancer types, stages, and HRV measurement methods.

Most studies focused on breast cancer and reported a predominant female population. Fatigue was the most studied symptom (n = 15), followed by pain (n = 7), and only one study assessed neuropathic symptoms. HRV measures included both time and frequency domain variables, with significant variability in measurement duration and control for confounding factors.

Findings suggest that decreased HRV is associated with increased fatigue and pain, providing potential support for a bidirectional relationship between autonomic dysfunction and these symptoms. However, the heterogeneity in HRV measurement methods and the high risk of bias in many studies highlight the need for high-quality prospective and interventional studies with standardized HRV protocols in cancer research.

The online version contains supplementary material available at 10.1007/s00520-025-10164-x.