Use of Heart Rate Variability (HRV) Biofeedback for Cancer Survivors

Cancer survivors often suffer from prolonged and persistent symptom clusters that can
include: pain, stress, depression, fatigue, and insomnia; symptoms that have each been
associated with inflammation. The number of cancer survivors in the United States is expected
to triple by the year 2030. Thus, there is a compelling need to develop and refine effective
methods to promote high quality cancer survivorship. Dysregulation of autonomic function is a
key pathophysiological 'common denominator' whereby many cancer-related symptoms likely
converge. Heart rate variability (HRV) is a valid, noninvasive measure of autonomic function
with established pathological and psychophysiological attributes. Reduced HRV is a known
mortality risk factor, and about 80% of advanced cancer patients exhibit autonomic
dysregulation. Cancer survivors with reduced HRV have increased mortality risk relative to
those with normal HRV. HRV biofeedback (HRV-B) is an interactive procedure whereby patients
learn to increase HRV and restore autonomic balance. HRV coherence refers to a state of
optimum HRV rhythm that produces physiological entrainment of HRV, respiration, and the
baroreflex. With HRV coherence, consecutive inter-beat intervals cycle from maximum to
minimum and back to maximum over a period of about 10 seconds, which is associated with
increased parasympathetic and decreased sympathetic tone, and a heightened state of
well-being including improved affect, cognition, and executive function. Previous research
suggests that HRV-B interventions may be useful for reducing symptoms of: chronic pain,
anxiety, depression, post-traumatic stress disorder (PTSD), heart disease, and insomnia.
HRV-B thus represents a promising complementary, nonpharmacological therapy that merits
examination for relief of chronic pain and related symptoms among cancer survivors.

Inclusion Criteria:

- histopathologically confirmed diagnosis of cancer having completed radiation or
chemotherapy

- 18 years of age or older

- English literate

Exclusion Criteria:

- patients receiving concurrent treatment for cancer except hormonal or biologic therapy

- patients with cardiovascular disorders that affect HRV parameters (paroxysmal
supraventricular tachycardia, atrial fibrillation, myocardial infarction within 12
months, unstable angina)

- patients receiving medications that affect cardiac rhythm (angiotensin converting
enzyme, calcium channel, or beta-adrenergic inhibitors)

- patients with a pacemaker or defibrillator

- patients who have had a heart transplant or by-pass surgery within 1 year

- patients with any active seizure disorder or use of antiseizure or anticonvulsant
medication prescribed specifically for seizure disorder

- patients with a pre-existing dementia prior to cancer diagnosis

- patients with a moderate (without good recovery) or severe head injury or stroke in
last 6 months

- patients with evidence of active substance abuse or dependence

- patients with a history of any major psychiatric disorder

- patients with a history of brain metastases, primary brain cancer, or altered
cognitive abilities

- patients with any use of long acting (extended release) opioid medications