Certain survivors of testicular cancer at greater risk for cardiovascular disease
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Key takeaways:
- Smoking, obesity and receipt of cisplatin combination chemotherapy increased risk for cardiovascular disease among testicular cancer survivors.
- Oncologists should encourage healthier lifestyles after treatment.
Survivors of testicular cancer often have undetected risk factors for cardiovascular disease that can lead to worse quality of life, according to data published in Journal of Clinical Oncology.
Having obesity or smoking at the beginning of treatment, as well as the development of Raynaud’s phenomenon or dyslipidemia after treatment or a family history of cardiovascular disease, appeared associated with increased risk for cardiovascular disease among these survivors, researchers wrote.
“In patients with [testicular cancer] who participated in the cardiometabolic study assessment, we observed a high prevalence of cardiovascular risk factors, which were often not previously identified and were thus untreated,” Sjoukje Lubberts, MD, of the department of medical oncology at University of Groningen in the Netherlands, and colleagues wrote. “This confirms the finding of a recent study that showed a higher prevalence of hypertension and hypercholesterolemia in [testicular cancer] survivors compared with the general male population, even from the start of treatment.”
Background and methodology
Survival rates of patients with testicular cancer have improved greatly since the introduction of platinum-based chemotherapy, with 5-year rates ranging from 99% to 70%, depending on localized or poor risk disease.
However, with incidence of the disease increasing, prevention and early detection of late adverse events after treatment have become increasingly important.
Prior studies have shown associations of testicular cancer treatment, especially platinum-based chemotherapy, with increased risk for cardiovascular morbidity and mortality; therefore, researchers sought to evaluate risk factors for development of cardiovascular disease following testicular cancer treatment.
The multicenter cohort included 4,748 patients who received treatment for testicular cancer at the ages of 12 to 50 years between 1976 and 2007. Researchers examined incidence of coronary artery disease, myocardial infarction and heart failure after treatment.
Patients who developed cardiovascular disease, as well as a random sample of study participants, received a questionnaire on cardiometabolic risk factors and quality of life. Researchers also evaluated cardiovascular risk factors among a subgroup of responders in the random sample.
Researchers noted a median follow-up of 16 years.
Results, next steps
Researchers identified 272 survivors who developed cardiovascular disease.
Results showed an association of cisplatin combination chemotherapy with an increased cardiovascular disease risk when compared with orchiectomy (HR = 1.9; 95% CI, 1.1-3.1).
Additional risk factors included having obesity at diagnosis (HR = 4.6; 95% CI, 2-10), being a smoker at diagnosis (HR = 1.7; 95% CI, 1.1-2.4), development of Raynaud’s phenomenon (HR = 1.9; 95% CI, 1.1-3.6), development of dyslipidemia (HR = 2.8; 95% CI, 1.6-4.7) or having a positive family history for cardiovascular disease (HR = 2.9; 95% CI, 1.7-4.9).
More survivors of testicular cancer with cardiovascular disease reported inferior quality of life than survivors who did not develop cardiovascular disease.
Among the 304 survivors (median age, 51 years) evaluated for cardiovascular risk factors, 86% had dyslipidemia, 50% had hypertension and 35% had metabolic syndrome, regardless of treatment.
“As soon as possible after diagnosis, these patients should be encouraged to adopt a healthy lifestyle: stop smoking, be physically active and maintain healthy dietary habits,” Lubberts and colleagues wrote. “Lifelong follow-up with low-threshold treatment of cardiovascular risk factors is needed, especially in obese and smoking patients treated with platinum-based chemotherapy.
“As oncologists, we should be working together with other health care professionals toward improving the lifespan and [quality of life] of these young men after we have treated them successfully for [testicular cancer],” they added.
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