Heart Rate Variability and Perceived Stress Relations Differ Between First-Diagnosed and Recurrent Bladder Cancer Patients

Abstract Background Bladder cancer (BC) remains a health concern with high recurrence rates, prompting novel approaches to risk assessment and monitoring. Beyond established clinicopathological markers, growing attention focuses on psychophysiological factors, including stress perception and autonomic nervous system (ANS) regulation. Heart rate variability (HRV), a non-invasive measure of ANS balance, may provide insights into physiological alterations in BC. Given individual variability in stress responses, this study examined whether HRV parameters and their associations with perceived stress differ between first-diagnosed patients, those with recurrent disease, and healthy controls. Methods The study included 30 first-diagnosed, 43 recurrent patients and 88 controls. Five-minute ECG recordings for HRV analysis were obtained using the Bittium Faros 180 device. Perceived stress was assessed with the Perceived Stress Scale (PSS). Results SNS and Stress indices were higher in first-diagnosed patients compared to recurrent patients and controls. Differences in mean HR, DFA-α2, and the PNS index were significant only between first-diagnosed patients and controls. Overall, BC patients showed lower vagally-related HRV parameters (SDNN, RMSSD, DCmod, SD1, PNS index), overall autonomic activity (TINN, total power), and higher sympathetically-related parameters (mean HR, ACmod, SNS, Stress index) than controls. Higher PSS correlated with increased sympathetic and decreased parasympathetic HRV, particularly in first-diagnosed patients. Conclusion Slovak BC patients demonstrated autonomic imbalance, with sympathetic dominance more pronounced in newly-diagnosed than recurrent patients; both groups showed greater imbalance than controls. HRV parameters also correlated more strongly with perceived stress in first-diagnosed patients. These findings support the value of psychophysiological and HRV monitoring in early BC care.