The interplay between breathing and experienced symptoms in cancer patients   April 9th, 2024

Patients with cancer experience acute and chronic symptoms such as pain, fatigue, insomnia, anxiety, depression and cognitive impairment. The co-occurence of these symptoms has been described as the symptom cluster, which is negatively associated with quality of life. One system that influences cancer and the related symptom cluster, is the autonomic nervous system. The autonomic nervous system consists of sympathetic and parasympathetic nerves that influence automatic functions of your body. The vagus nerve is the main nerve of the parasympathetic nervous system, which affects crucial bodily functions such as breathing, heart rate, digestion, but also control of mood and immune response. Vagal nerve activity also inhibits inflammation, oxidative stress and sympathetic activity.

In summary, stimulation of the vagus nerve can stimulate the parasympathetic system, which sequentially may lead to a global reduction of the symptom cluster in cancer patients. A low threshold and accessible non-pharmacological way to stimulate the vagal nerve is by performing slow-paced breathing. Therefore, in our study, we will examine the effect of slow-paced breathing (Protocol by Lehrer) on the experienced symptom cluster in cancer patients.

During a 6-week trial, patients are tested at baseline (week 1) and at the end of the study (post test, week 6) by means of validated surveys and an objective measure of heart rate variability (PPG Stressflow®). During the first session, all participants are given instructions to perform the breathing exercises twice a day as described by Lehrer and by means of a HeartMath® breath pacer. During these six weeks, all patients receive a follow-up call at week 2 and 4. Recruitment and data collection is currently ongoing and results are pending.

Researchers at Odisee University of Applied Sciences (dr. Julie Vanderlinden and drs. Liza Much) have been working together with master students from Berekuyl Academy and VUB during the trial. In order to continue the trial, we are still recruiting patients.

Call to action:

-If you know patients with cancer that might be interested in participating in this trial, we are happy to provide more information.

-If you are happy to collaborate as a researcher or clinician.

In either case, please contact

-If you are interested to learn more about our research, please visit our project website:

dr. Julie Vanderlinden (PhD)

Julie is the head of the research lab Active neighborhoods and lifestyle interventions at the Odisee University of Applied Sciences and is affiliated with PIM as a voluntary postdoctoral researcher. Her research is focused on the effects of behavioral, lifestyle and non-pharmacological interventions on several aspects of mental wellbeing such as sleep, distress and resilience. Besides research, Julie is involved in teaching in different health programs. Furthermore, she works as a sleep therapist in a general physicians’ practice in Mechelen. Her passion therein is to empower patients, educate health care professionals and stimulate policy makers to increase the uptake of healthy sleep habits in general.

2024Pain in Motion

References and further reading:

  1. Stapleton SJ, Holden J, Epstein J, Wilkie DJ. Symptom clusters in patients with cancer in the hospice/palliative care setting. Support Care Cancer. 2016;24(9):3863-71.
  2. Barsevick AM, Aktas A. Cancer symptom cluster research: new perspectives and tools. Curr Opin Support Palliat Care. 2013;7(1):36-7.
  3. Karemaker JM. An introduction into autonomic nervous function. Physiol Meas. 2017;38(5):R89-r118.
  4. De Couck M, Nijs J, Gidron Y. You may need a nerve to treat pain: the neurobiological rationale for vagal nerve activation in pain management. Clin J Pain. 2014;30(12):1099-105.
  5. Reijmen E, Vannucci L, De Couck M, De Grève J, Gidron Y. Therapeutic potential of the vagus nerve in cancer. Immunology Letters. 2018;202:38-43.
  6. Lehrer, P., Vaschillo, B., Zucker, T., Graves, J., Katsamanis, M., Aviles, M., & Wamboldt, F. (2013). Protocol for heart rate variability biofeedback training. Biofeedback, 41(3), 98–109.
  7. Welzijnverbetering bij kankerpatiënten en hun mantelzorgers. Odisee Hogeschool (2023):