title: Heart rate variability measure in breast cancer patients and survivors: A systematic review.
abstract: In the current study, we aimed to review literature findings showing the clinical importance of cardiac autonomic modulation assessed by heart rate variability analysis in breast cancer (BC) patients and survivors.
  
  
  
  We conducted a systematic review according to The PRISMA Statement in Medline, Scopus and Web of Science (_-2015) databases. The search was limited to articles in English language, published in peer-reviewed journals, and with adult age samples only (e.g., women, patients, or survivors, diagnosed with BC in any stage). We included observational studies and randomized trials. Detailed heart rate variability analysis (instruments, data collection protocol, and analysis methods) was required. Search terms included autonomic nervous system, heart rate variability, sympathetic and parasympathetic nervous system, autonomic dysfunction, vagal nervous and breast neoplasms, breast cancer and breast tumor.
  
  
  
  Twelve studies were included in this review. The clinical importance of cardiac autonomic modulation assessed by heart rate variability analysis in BC patients and survivors is demonstrated by association with effects of BC surgery, and treatments, and the adverse effects of surgery and treatments on survivors (e.g., cardiotoxicity, fatigue, and stress).
  
  
  
  The strength of evidence of included studies is low: small samples size and heterogeneity, presence of confounders, and observational studies design.
  
  
  
  The heart rate variability analysis could be used as a complementary non-invasive tool for the early diagnosis and better prognosis of autonomic dysfunction, and survival in BC patients. There are many potential clinical applications of heart rate variability analysis in BC patients, and the employment of such approaches could lead to lower impairment of autonomic function in this individuals.
authors.affiliation: Departamento de Medicina (Cardiologia), Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), 715 Napoleão De Barros St., São Paulo, SP 04024-002, Brazil. Electronic address: ac.arabclaudia@gmail.com.
authors.forename: Claudia
authors.initials: C
authors.lastname: Arab
authors.affiliation: Departamento de Fisiologia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo (USP), 3900 Bandeirantes Av, Ribeirão Preto, SP 14049-900, Brazil. Electronic address: danielpenteado@gmail.com.
authors.forename: Daniel Penteado Martins
authors.initials: DP
authors.lastname: Dias
authors.affiliation: Departamento de Saúde da Coletividade, Faculdade de Medicina do ABC (FMABC), 821 P Rincipe De Gales Av, Santo Andre, SP 09060-650, Brazil. Electronic address: profrenatathais@gmail.com.
authors.forename: Renata Thaís de Almeida
authors.initials: RT
authors.lastname: Barbosa
authors.affiliation: Departamento de Saúde da Coletividade, Faculdade de Medicina do ABC (FMABC), 821 P Rincipe De Gales Av, Santo Andre, SP 09060-650, Brazil. Electronic address: carvalho.td1@gmail.com.
authors.forename: Tatiana Dias de
authors.initials: TD
authors.lastname: Carvalho
authors.affiliation: Centro de Estudos do Sistema Nervoso Autônomo, Departamento de Fonoaudiologia, Faculdade de Filosofia e Ciências, Universidade Estadual Paulista "Júlio de Mesquita Filho" (UNESP), 737 Hygino Muzzi Filho Av, Marília, SP 17525-901, Brazil. Electronic address: vitor.valenti@gmail.com.
authors.forename: Vitor Engrácia
authors.initials: VE
authors.lastname: Valenti
authors.affiliation: Departamento de Saúde da Coletividade, Faculdade de Medicina do ABC (FMABC), 821 P Rincipe De Gales Av, Santo Andre, SP 09060-650, Brazil. Electronic address: taniabrusque@gmail.com.
authors.forename: Tânia Brusque
authors.initials: TB
authors.lastname: Crocetta
authors.affiliation: Departamento de Saúde da Coletividade, Faculdade de Medicina do ABC (FMABC), 821 P Rincipe De Gales Av, Santo Andre, SP 09060-650, Brazil. Electronic address: doutormarcelof@gmail.com.
authors.forename: Marcelo
authors.initials: M
authors.lastname: Ferreira
authors.affiliation: Departamento de Saúde da Coletividade, Faculdade de Medicina do ABC (FMABC), 821 P Rincipe De Gales Av, Santo Andre, SP 09060-650, Brazil; Faculdade de Saúde Pública, Universidade de São Paulo (USP), 715 Doutor Arnaldo Av, Sao Paulo, SP 01246-904, Brazil. Electronic address: abreu.luizcarlos@gmail.com.
authors.forename: Luiz Carlos de
authors.initials: LC
authors.lastname: Abreu
authors.affiliation: Departamento de Medicina (Cardiologia), Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), 715 Napoleão De Barros St., São Paulo, SP 04024-002, Brazil. Electronic address: ferreira-celso@uol.com.br.
authors.forename: Celso
authors.initials: C
authors.lastname: Ferreira
mesh_terms: D000328:Adult; D001341:Autonomic Nervous System / Q000503:physiopathology; D001943:Breast Neoplasms / Q000503:physiopathology*; D005260:Female; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D010275:Parasympathetic Nervous System / Q000503:physiopathology; D017741:Survivors
keywords: Autonomic nervous system; Breast neoplasm; Cardiac electrophysiology; Cardiovascular physiology; Parasympathetic nervous system; Sympathetic nervous system