Home » Research » Palliative Care Research Studies » Understanding a potential cause for fatigue in cancer

Cardio-Oncology and Cancer-Related Fatigue – Understanding a potential cause for fatigue in cancer

Research Project Title

Cardiac And Cardiovascular Autonomic Nervous System Function In Cancer-Related Fatigue


Cardio-Oncology; Cancer-Related Fatigue; Autonomic Nervous System; Pathophysiology of Fatigue


Fatigue is one of the most common and most troublesome symptoms faced by those with cancer. And yet, we do not have a clear understanding of how it is caused and why it affects some people more than others. One possible cause is through the effect of cancer on heart muscle or on the autonomic nervous system (a part of the nervous system which regulates bodily functions such as heart rate and blood pressure). Cancer can cause changes in heart function that is separate to any side effects that are caused by cancer treatment, and these changes can be present at cancer diagnosis. My project was aimed at identifying cardiac and autonomic nervous system function in patients with cancer, and examining whether this was linked to cancer-related fatigue. 

Research Project aims and methods

The aim of the study was to assess a possible cause for cancer-related fatigue, focusing on heart and autonomic nervous system function. I did this through a number of studies – a review of the literature on the effect of cancer on heart function, separate to any treatment related effects; a study examining people with newly diagnosed cancer, assessing fatigue, heart and autonomic nervous system function; a study assessing the same areas in patients attending palliative care services; and a study examining the links between skeletal muscle weakness and heart muscle.

Public, patient and personal involvement (PPI)

There was no formal PPI within this project, which is a limitation of the research. It was approved by research ethics groups which included patient representatives.

Key Findings & Recommendations

My scoping review supported the theory that cardiac and cardiovascular changes can be caused by cancer directly, in those who have not had any treatment.

The study in newly diagnosed cancer patients demonstrated a high level of self-reported fatigue in this group, and a high level of changes in the diastolic function of the heart, and in autonomic nervous system function, with associations between these aspects.

In the group of patients attending palliative care services, measurement of these areas was found to be possible, and this group had similar difficulties with fatigue, diastolic and autonomic nervous system changes.

Finally, skeletal muscle loss and changes in heart muscle were present in a group newly diagnosed with cancer of the oesophagus, with links between the two.


Main project recruitment and analysis: September 2016-January 2021

Dissemination: ongoing

Research Team

Dr. Bernadette Brady, Lead researcher, Consultant in Palliative Medicine.

Academic Department of Palliative Medicine, Our Lady’s Hospice & Care Services; University College Dublin

Michelle Barrett, Research Nurse. Academic Department of Palliative Medicine (prev)

Dr. Gerard King, Research Physiologist, Institute of Cardiovascular Science, St. James’s Hospital

Dr. Ross Murphy, Consultant Cardiologist. Institute of Cardiovascular Science, St. James’s Hospital

Prof Declan Walsh, Professor in Palliative Medicine. Project supervisor. Academic Department of Palliative Medicine (prev). Department of Supportive Oncology, Levine Cancer Institute, Atrium Health, NC, USA


Oncology Team, St. James’s Hospital

Cardiology Team, St. James’s Hospital

Palliative Care service, St. James’s Hospital & Our Lady’s Hospice & Care Services.

Funding & Support

PhD Scholarship – Atlantic Philanthropies

Research Project Outputs and impact:

Published Work:  
The pathophysiology of cancer-related fatigue: Current controversies  
O’Higgins, C.M., Brady, B., O’Connor, B. et al. Supportive Care Cancer (2018) 26: 3353.  

Myocardial strain: A clinical review 
B Brady, G King, RT Murphy, D Walsh 
Irish Journal of Medical Science (1971-) 192 (4), 1649-1656 

Cancer treatment-related cardiac dysfunction 
B Brady, R Murphy 
BMJ Supportive & Palliative Care 13 (1), 53-56 

Cardiac and Cardiovascular Autonomic Nervous System Function in Cancer-related Fatigue 
B Brady 
University College Dublin (PhD thesis) 

In Press: 
Cardiac dysfunction in solid tumours – a neglected problem. A cardio-oncology scoping review
BMJ Supportive & Palliative Care 
Cardio-oncology in newly diagnosed oesophageal carcinoma: sarcopenia predictive of cardiac diastolic dysfunction on echocardiography. A retrospective cohort study 
The Journal of Cardiovascular Aging

Invited Speaker: 
Pathophysiology of cancer-related fatigue
Irish Association for Cancer Research
Galway, February 2020 

Related prior work:

Aktas A, Walsh D, Lasheen W, Brady B, Barrett M, Estfan B. Cardiovascular vital signs at solid tumor diagnosis: hypotension and tachycardia predict shorter overall survival. European Journal of Cardiovascular Disease 2022; 1: 6-10 

For Further Information: