Heart Rate Variability Biofeedback in Cancer Patients: A Scoping Review

Abstract

Heart Rate Variability (HRV) Biofeedback (BFB) has been shown to improve autonomic balance and wellbeing in chronic diseases. As cardiac variability represents an index of cognitive and emotional regulation, HRV-BFB has been shown to lead to improvements in physiological and psychological adaptability and quality of life. However, knowledge of HRV-BFB in cancer patients is lacking, and available results are diversified according to methods and outcomes. The present paper undertakes a scoping review, exploring the use of HRV-BFB to modulate autonomic balance, cancer symptom management, and quality of life in cancer. This scoping review analyzes empirical evidence considering study designs, BFB methods, and psychophysiological outcomes. Research that focused on HRV-BFB effects in cancer patients was selected (79%). In addition, a systematic review and meta-analysis (31%) focusing on HRV, or BFB in chronic conditions, including cancer, were considered. The studies examined BFB treatment for thyroid, lung, brain or colon cancer, hematologic cancer, and survivors or terminal cancer patients. Retrieved studies reported physiological and psychological indices as primary outcomes: they included HRV values, sleep, pain, fatigue, depression, anxiety, and quality of life. Although the heterogeneity of publications makes it difficult to generalize the effectiveness of HRV-BFB, the training has been proven to improve cancer symptoms and well-being.

Keywords: autonomic balance; biofeedback; cancer; decision-making; heart rate variability; quality of life.

Figure 1

PRISMA 2020 flow diagram for the review process. * Reason 1: BFB on other physiological signals (e.g., electromyography, temperature, skin conductance); reason 2: HRV assessment without BFB; reason 3: unclear primary or secondary outcomes; reason 4: sample of patients without cancer diagnosis. Reprinted with permission from Page et al. (2021). Copyright 2020 The PRISMA statement.