{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,15]],"date-time":"2026-03-15T07:09:57Z","timestamp":1773558597724,"version":"3.50.1"},"reference-count":32,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2025,2,21]],"date-time":"2025-02-21T00:00:00Z","timestamp":1740096000000},"content-version":"vor","delay-in-days":20,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000048","name":"American Cancer Society","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000048","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cancer Medicine"],"published-print":{"date-parts":[[2025,2]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Adolescents and young adults (AYAs) receiving hematopoietic cell transplantation (HCT) are at high risk for poor psychosocial outcomes. Heart rate variability (HRV), a surrogate for autonomic nervous system activity, is a promising digital biomarker that has been linked to important outcomes. The objectives of this study were to prospectively describe the trajectory of HRV among AYAs receiving HCT and explore the association between HRV and patient\u2010reported outcomes (PROs).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This was a multi\u2010site study embedded in a randomized trial among AYAs receiving HCT (NCT03640325). We collected sequential 24\u2010h HRV metrics, including the standard deviation of normal\u2010to\u2010normal beats (SDNN), root\u2010mean\u2010square of successive differences (RMSSD), as well as frequency domain measures. PRO surveys queried anxiety, depression, quality of life, hope, and resilience at baseline and 3\u2009months. We summarized outcomes using descriptive statistics, and Pearson correlation coefficients were used to examine the relationship between HRV and PROs.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Thirty\u2010nine HRV recordings were collected from <jats:italic>n<\/jats:italic>\u2009=\u200916 participants aged 12\u201321\u2009years. There was a moderately strong correlation between inferior baseline HRV and higher anxiety and depression (anxiety: <jats:italic>r<\/jats:italic>\u2009=\u2009\u22120.35 (<jats:italic>p<\/jats:italic>\u2009=\u20090.18) for SDNN, <jats:italic>r<\/jats:italic>\u2009=\u2009\u22120.47 (<jats:italic>p<\/jats:italic>\u2009=\u20090.07) for RMSSD; depression: <jats:italic>r<\/jats:italic>\u2009=\u2009\u22120.26 (<jats:italic>p<\/jats:italic>\u2009=\u20090.34) for SDNN, <jats:italic>r<\/jats:italic>\u2009=\u2009\u22120.39 (<jats:italic>p<\/jats:italic>\u2009=\u20090.14) for RMSSD). Among participants with elevated baseline anxiety, higher HRV suggested greater improvement in anxiety over time (<jats:italic>r<\/jats:italic>\u2009=\u2009\u22120.66 (<jats:italic>p<\/jats:italic>\u2009=\u20090.08) for SDNN, <jats:italic>r<\/jats:italic>\u2009=\u2009\u22120.31 (<jats:italic>p<\/jats:italic>\u2009=\u20090.45) for RMSSD).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>There was a correlation between HRV and PROs in this study, and among those with elevated anxiety, HRV predicted improvement over time. Digital biomarkers may augment behavioral intervention design and implementation.<\/jats:p><\/jats:sec>","DOI":"10.1002\/cam4.70609","type":"journal-article","created":{"date-parts":[[2025,2,21]],"date-time":"2025-02-21T11:16:54Z","timestamp":1740136614000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Heart Rate Variability as a Digital Biomarker in Adolescents and Young Adults Receiving Hematopoietic Cell Transplantation"],"prefix":"10.1002","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8998-4530","authenticated-orcid":false,"given":"Mallory R.","family":"Taylor","sequence":"first","affiliation":[{"name":"Department of Pediatrics University of Washington School of Medicine  Seattle Washington USA"},{"name":"Ben Towne Center for Childhood Cancer and Blood Disorders Research Seattle Children's Research Institute  Seattle Washington USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Miranda C.","family":"Bradford","sequence":"additional","affiliation":[{"name":"Biostatistics Epidemiology and Analytics in Research Core Seattle Children's Research Institute  Seattle Washington USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chuan","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Pediatrics University of Washington School of Medicine  Seattle Washington USA"},{"name":"Center for Child Health, Behavior, and Development Seattle Children's Research Institute  Seattle Washington USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kaitlyn M.","family":"Fladeboe","sequence":"additional","affiliation":[{"name":"Department of Pediatrics University of Washington School of Medicine  Seattle Washington USA"},{"name":"Ben Towne Center for Childhood Cancer and Blood Disorders Research Seattle Children's Research Institute  Seattle Washington USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jorie F.","family":"Wittig","sequence":"additional","affiliation":[{"name":"University of Washington School of Medicine  Seattle Washington USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"K. Scott","family":"Baker","sequence":"additional","affiliation":[{"name":"Department of Pediatrics University of Washington School of Medicine  Seattle Washington USA"},{"name":"Clinical Research Division Fred Hutchinson Cancer Research Center  Seattle Washington USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joyce P.","family":"Yi\u2010Frazier","sequence":"additional","affiliation":[{"name":"Department of Psychosocial Oncology and Palliative Care Dana\u2010Farber Cancer Institute  Boston Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7608-607X","authenticated-orcid":false,"given":"Abby R.","family":"Rosenberg","sequence":"additional","affiliation":[{"name":"Department of Psychosocial Oncology and Palliative Care Dana\u2010Farber Cancer Institute  Boston Massachusetts USA"},{"name":"Department of Pediatrics Boston Children's Hospital  Boston Massachusetts USA"},{"name":"Department of Pediatrics Harvard Medical School  Boston Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,2,21]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/pbc.27486"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1038\/bmt.2010.74"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bbi.2013.01.003"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41386-020-0761-5"},{"issue":"22","key":"e_1_2_11_6_1","first-page":"2100","article-title":"Wearable Digital Health Technology","volume":"389","author":"Friend S. 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