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Research Library

Symptom Management Among Cancer Survivors: Randomized Pilot Intervention Trial of Heart Rate Variability Biofeedback

    • Published: 2020
    • James B. Burch1,2,3,7, J. P. Ginsberg4, Alexander C. McLain1, Regina Franco5, Sherry Stokes6, Kerri Susko5, William Hendry5, Elizabeth Crowley5, Alex Christ5, John Hanna5, Annie Anderson5, James R. H├ębert1,2, and Mark A. O'Rourke5
    • Springer Science+Business Media, LLC, part of Springer Nature, 2020. DOI: 10.1007/s10484-020-09462-3.1. Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC, USA. 2. South Carolina Statewide Cancer Prevention and Control Program, University of South Carolina, Columbia, SC, USA. 3. WJB Dorn Department of Veterans Affairs Medical Center, Columbia, SC, USA. 4. Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA. 5. Integrative Oncology, PRISMA Health Upstate Cancer Institute, Greenville, SC, USA. 6. Clemson University, Clemson, SC, USA. 7. Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.
    • Download the complete paper, click here.


Chronic cancer-related symptoms (stress, fatigue, pain, depression, insomnia) may be linked with sympathetic nervous system over-activation and autonomic imbalance. Decreased heart rate variability (HRV) is an indicator of autonomic dysregulation that is commonly observed among cancer survivors. HRV biofeedback (HRVB) training induces HRV coherence, which maximizes HRV and facilitates autonomic and cardiorespiratory homeostasis. This randomized, wait-list-controlled, pilot intervention trial tested the hypothesis that HRVB can improve HRV coherence and alleviate cancer-related symptoms. The intervention group (n = 17) received 4-6 weekly HRVB training sessions until participants demonstrated skill acquisition. Controls (n = 17) received usual care. Outcomes assessed at baseline and follow-up included 15-min HRV recordings (HRV Coherence Ratio), and symptoms of: stress, distress, post-traumatic stress disorder (PTSD), pain, depression, fatigue, and sleep disturbance. Linear mixed models for repeated measures were used to assess Group-by-Time interactions, pre- versus post-treatment differences in mean symptom scores, and group differences at follow-up. Mean HRV Coherence Ratios (± standard error) improved in the HRVB group at follow-up (baseline: 0.37 ± 0.05, post-intervention: 0.84 ± 0.18, p = 0.01), indicating intervention validity. Statistically significant Group-by-Time interactions indicated treatment-related improvements in HRV Coherence Ratios (p = 0.03, Pre-vs. post-treatment effect size [Cohen’s d]: 0.98), sleep symptoms (p = 0.001, d = 1.19), and sleep-related daytime impairment (p = 0.005, d = 0.86). Relative to controls, the intervention group experienced trends toward improvements in stress, distress, fatigue, PTSD, and depression, although no other statistically significant Group-by-Time interactions were observed. This pilot intervention found that HRVB training reduced symptoms of sleep disturbance among cancer survivors. Larger-scale interventions are warranted to further evaluate the role of HRVB for managing symptoms in this population.