Electrocardiographic changes and their impact on psychological distress and sleep quality in breast cancer patients during anthracycline-based chemotherapy

Background: Breast cancer is the most common malignant tumor in women. Anthracycline is an essential adjuvant chemotherapy drug. Due to its cardiotoxicity, anthracyclines may lead to abnormal electrocardiogram, which may induce anxiety, depression and sleep disorders. Current studies mainly focus on the changes of echocardiogram parameters and serum myocardial markers, and the dynamic evolution of electrocardiogram. However, the mechanism of its interaction with psycho-sleep are still unclear. Objective: To analyze the electrocardiogram results of breast cancer patients with anthracycline chemotherapy, and to analyze its correlation with psychological disorders and sleep quality. Methods: In this longitudinal observational study, 100 breast cancer patients receiving anthracycline-based chemotherapy underwent 12-lead electrocardiogram (ECG) monitoring at three time points: within 7 days before chemotherapy initiation (T0), 24 hours after the completion of the second chemotherapy cycle (T1), and 24 hours after the completion of the fourth cycle (T2). QTc intervals and ST-segment changes were recorded. Concurrent psychological and sleep status assessments were performed using the Hospital Anxiety and Depression Scale (HADS) and the Pittsburgh Sleep Quality Index (PSQI). Results: After the fourth cycle of chemotherapy (T2), 36 patients had abnormal electrocardiogram (ECG), and the overall abnormal rate increased from 3% to 36.0%, mainly manifested as QTc prolongation (16.0%), ST segment depression (11.0%) and T wave changes (17.0%). Patients with age ≥ 50, BMI ≥ 24kg/m2, postmenopausal, TNM stage III, cumulative drug dose ≥300 mg/m2, hypertension, hyperlipidemia and other characteristics have a higher probability of abnormal ECG after chemotherapy. Psychological assessment showed that HADS-A and HADS-D scores increased from 5.71 ± 2.24 and 5.06 ± 1.73 at T0 to 9.74 ± 3.11 and 9.15 ± 2.80 at T2, respectively (P < 0.001). The incidence of anxiety increased from 13% (T0) to 42% (T2), and the incidence of depression increased from 10% to 36% (P < 0.001). HADS-A and HADS-D in the abnormal ECG group were significantly higher than those in the normal ECG group. There were significant differences in the incidence of anxiety (69.4% vs. 26.6%) and depression (55.6% vs. 25%) between the two groups (P < 0.01). The total score of PSQI was 5.49 ± 2.35 at T0, 7.53 ± 2.84 at T1, and 10.60 ± 3.67 at T2. ECG abnormalities were positively correlated with HADS-A (r = 0.522, P < 0.01), HADS-D (r = 0.439, P < 0.01) and PSQI (r = 0.706, P < 0.01). HADS-A (r = 0.655, P < 0.01) and HADS-D (r = 0.547, P < 0.01) were positively correlated with PSQI. Conclusion: Breast cancer patients undergoing anthracycline-based chemotherapy frequently exhibit characteristic ECG changes, including QT interval prolongation and ST-T segment abnormalities. These ECG abnormalities are associated with anxiety and depressive symptoms during treatment, as well as significantly aggravated sleep disturbances, suggesting a potential bidirectional interaction between cardiac function and neuropsychological health throughout the chemotherapy process.