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Morbidity burden identifies testicular cancer survivors who need close monitoring
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Factors associated with higher cumulative burden of morbidity may be useful for identifying survivors of testicular cancer who need closer monitoring, according to findings published in Journal of Clinical Oncology.
“An important population in which to assess adverse health outcomes are survivors of testicular cancer, the most common cancer in men ages 18 to 39 years,” Sarah L. Kerns, PhD, MPH, assistant professor at University of Rochester Medical Center, and colleagues wrote. “Since effective cisplatin-based chemotherapy was introduced in the 1970s, the overall age-adjusted 5-year relative survival rate is more than 95%, and survivors remain at risk for decades for the late effects of cancer and its treatment.
“A better understanding of adverse health outcomes may help to guide testicular cancer management, especially in the controversial area of whether good-risk patients should receive four cycles of etoposide plus cisplatin or three cycles of bleomycin, etoposide and cisplatin,” they added.
The researchers conducted a multi-institutional study of 1,214 men (median age, 37 years; range, 18-74) who survived testicular cancer. Patients had been aged younger than 55 years when diagnosed and had completed first-line chemotherapy at least 1 year prior to the beginning of the study (median time since chemotherapy completion, 4.2 years; range, 1-30). All patients completed a questionnaire and received a physical examination.
Kerns and colleagues reviewed treatment data from the patients’ medical records and assessed the number and severity of adverse health outcomes using a cumulative burden of morbidity score.
Common adverse health outcomes observed in the population included obesity, sensory neuropathy, tinnitus, hearing damage, Raynaud phenomenon and pain.
Nearly one-fifth of patients had a high (15%) or very high/severe (4.1%) cumulative burden of morbidity score, whereas most demonstrated a medium (30%) or low to very low score (47%).
Treatment impacted morbidity scores. Four cycles of ifosfamide, etoposide and cisplatin (OR = 1.96; 95% CI, 1.04-3.71) or bleomycin, etoposide and cisplatin (OR = 1.44; 95% CI, 1.04-1.98) increased odds of having a higher score. However, the difference in risk between the two chemotherapy regimens did not reach statistical significance.
Other factors associated with higher score included older attained age (OR = 1.18; 95% CI, 1.1-1.26), being on disability leave (OR = 3.53; 95% CI, 1.57-7.95), having less than a college education (OR = 1.44; 95% CI, 1.11-1.87), and being a current or former smoker (OR = 1.28; 95% CI, 1.02-1.63).
Researchers found Asian race (OR = 0.41; 95% CI, 0.23-0.72) and vigorous exercise (OR = 0.68; 95% CI, 0.52-0.89) to be protective against higher scores.
Variable clustering analyses showed six significant clusters of adverse health outcomes. These included hearing loss and damage and tinnitus (OR = 16.3); hyperlipidemia, hypertension and diabetes (OR = 9.8); neuropathy, pain and Raynaud phenomenon (OR = 5.5); cardiovascular and related conditions (OR = 5); thyroid disease and erectile dysfunction (OR = 4.2), and depression or anxiety and hypogonadism (OR = 2.8).
“Ongoing genetic research in the current cohort has already begun to characterize biologic pathways that underlie cisplatin-related toxicities and that can identify new research opportunities aimed at developing agents to prevent, mitigate and treat adverse sequelae not only among testicular cancer survivors but also among other survivors after cisplatin-based chemotherapy,” the researchers wrote. “In the interim, if confirmed, the current results could inform survivorship care strategies and assist health care providers in identifying conditions, or groups of conditions, for which to screen, counsel and treat testicular cancer survivors.” – by Andy Polhamus
Disclosures: Kerns reports no relevant financial disclosures. Please see the study for a list of all other authors’ relevant financial disclosures.
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