Table 8 Good laboratory practice recommendations and considerations for ANS and CV testing in cancer

Patient recruitment, access and retention

1. Recruit young adults from expanded age range (18–45 vs. 18–39).

• Boosts recruitment opportunity without exposing sample to preexisting ANS/CV morbidity and use of related medications.

2. Prescreen for age and diagnosis (given the absence of underlying confounding morbidity).

3. YA cancer patients appear highly motivated and capable of participating in studies of this nature.

• Observational results - therefore, cannot generalize findings to intervention trials.

Pre-Chemotherapy baseline

4. Ensure unrestricted testing facility access.

• YAs are at a higher risk of late- and misdiagnosis [68, 69], which may increase the likelihood of advanced staging at diagnosis and shorten the available pre-treatment testing window.

• Investigators should make every attempt to anticipate, screen for and test patients prior to their beginning pre-treatment symptom management medication.

Test rerformance and tolerability

5. Proceed with CASS test battery as described.

• No differences in test tolerability or performance between patients and controls.

Use of potentially confounding medication

6. Identify an assessment window which minimizes the influence of PCM.

• For 2–4 weeks/cycle treatment protocols, assessments should be made between 3 and 6 days prior to subsequent treatment cycle.

• For 1 week/cycle treatment protocols, coordinating with the treating oncologist may be required to establish the requisite assessment opportunity.

7. Record and report PCM use in all observation and intervention trials.

• In addition to primary anti-cancer treatments and commonly prescribed symptom-management medications (i.e. anti-emetic and pain-management), we identified the occasional use of additional medications (i.e. antidepressant and sleep-aids) which may influence ANS and CV testing.

Additional considerations

8. Systemic anticancer therapies are known to injure/perturb multiple CV system components.

∴Aberrant ANS test results may reflect end-organ dysfunction and not ANS dysfunction.

∴Include complementary CV and end-organ function tests in ANS-oncology research.

9. The single stage Astrand-Ryhming may lack sensitivity.

∴ Consider a submaximal or maximal incremental ramp exercise protocol instead.

10. Investigators should assess and account for differences in aerobic fitness, physical activity and fatigue levels, given their relationships with measures of ANS function [3, 47, 51, 53].