Autonomic dysfunction in patients with advanced cancer; prevalence, clinical correlates and challenges in assessment.
Citation:
Stone CA, Kenny RA, Nolan B, Lawlor PG., Autonomic dysfunction in patients with advanced cancer; prevalence, clinical correlates and challenges in assessment., BMC Palliative Care, 11, 3, 2012, 1-8Download Item:
Abstract:
Background: The results of a small number of studies of autonomic function in patients with advanced cancer
suggest that autonomic dysfunction (AD) is common. In other disease-specific groups this is associated with
decreased survival, falls and symptoms such as postural hypotension, nausea, early satiety and fatigue. The
contribution of AD to symptoms in advanced cancer is unknown.
Methods: We conducted a prospective cohort study designed to identify the risk factors for falls in patients with
advanced cancer. Ambulant adult patients admitted consecutively to palliative care services were invited to
participate. Participants underwent an assessment at baseline which included standard clinical tests of autonomic
function, assessment of symptom severity, muscle strength, anthropometric measurements, walking speed,
medication use, comorbidities and demographics. Information regarding survival was recorded ten months
following cessation of recruitment. The clinical correlates of AD, defined as definite or severe dysfunction using
Ewing?s classification, were examined by univariate and multivariate logistic regression analysis. Survival analysis was
conducted using Kaplan-Meier plots and the log rank test.
Results: Of 185 patients recruited, 45% were unable to complete all of the clinical tests of autonomic function.
Non-completion was associated with scoring high on clinical indicators of frailty. It was possible to accurately
classify 138/185 (74.6%) of participants as having either definite or severe versus normal, early or atypical AD: 110
(80%) had definite/severe AD. In logistic regression analysis, age (OR = 1.07 [95% CI; 1.03-1.1] P = 0.001) and
increased severity of fatigue (OR = 1.26 [95% CI; 1.05-1.5] p = 0.016) were associated with having definite/severe
AD. In analysis adjusted for age, median survival of participants with definite/severe AD was shorter than in those
with normal/early/atypical classification (c2 = 4.3, p = 0.038).
Conclusions: Autonomic dysfunction is highly prevalent in patients with advanced cancer and is associated with
increased severity of fatigue and reduced survival. Due to frailty, up to 45% of participants were unable to
complete standard clinical tests of autonomic function. In order to further investigate the impact of AD and the
therapeutic potential of treatment of AD in patients with advanced cancer, the validity of alternative novel
methods of assessing autonomic function must be appraised.
Author's Homepage:
http://people.tcd.ie/rkennyDescription:
PUBLISHEDPMID: 22379978
Author: KENNY, ROSE ANNE
Type of material:
Journal ArticleSeries/Report no:
BMC Palliative Care11
3
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autonomic functionMetadata
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