Adverse health outcomes (AHO) in testis cancer survivors (TCS) following high-dose chemotherapy (HDCT) and autologous stem cell transplant.

Abstract

12083 Background: Patients with relapsed/refractory germ cell tumors are often cured with tandem platinum-based HDCT followed by autologous stem cell transplant in the ≥2nd line treatment setting. A comprehensive assessment of long-term AHO (adverse health outcomes) in TCS cured with HDCT has not been previously described. Methods: Testis cancer survivors (TCS) at least 1 year after HDCT and treated at Indiana University were eligible. TCS were asked to complete a comprehensive, well validated survey regarding 19 different AHO. TCS demographics, disease characteristics, treatment received, and AHO were collected. Results: From 2/2021-1/2022, 118 eligible TCS were invited. 70 TCS completed the survey (59.3% completion rate). TCS received HDCT followed by autologous stem cell transplant in the 2nd (91.4%), 3rd (7.1%) or 4th line (1.4%) setting. At the time of survey completion, 93% of respondents were at least two years from HDCT (range 1.6-16.2 y) with a median age of 42 y (range 24.8-66.6 y). Median age at the time of original germ cell tumor diagnosis was 32 y (range 17.4-56.8 y). TCS reported a median of 3 AHO with 37% of participants reporting 5 or more AHO. 90% of participants reported tinnitus, 91% experienced hearing impairment, and 52% required the use of hearing aids. Additionally, 46% TCS noted peripheral neuropathy and 26% reported problems with balance/vertigo/dizziness. Prevalence of kidney disease was 10%, and 24% TCS experienced erectile dysfunction. In regards to physical activity, 47% of participants were not participating in vigorous physical activity (defined as > 6 mets/week). 16% TCS reported use of medications to treat anxiety and/or depression, and 19% required testosterone replacement therapy. The prevalence of hypertension, coronary artery disease, Raynaud phenomenon, hypercholesterolemia, diabetes, and thyroid disease were 13%, 1%, 17%, 12%, 4%, and 6% respectively. Conclusions: Despite the high cure rate of HDCT, TCS report a substantial burden of morbidity with the majority experiencing ototoxicity, and with half of the TCS requiring hearing aids. Special attention to these AHO and efforts to develop ototoxicity prevention approaches are urgently needed for this patient population.