Abstract
We evaluated for the first time, to our knowledge, adverse health outcomes (AHOs) among US testicular cancer survivors (TCS) given chemotherapy (n = 381) vs surgery-only patients (n = 98) managed at a single institution, accounting for non-treatment-related risk factors to delineate chemotherapy’s impact. Chemotherapy consisted largely of bleomycin-etoposide-cisplatin (BEP) administered in three or four cycles (BEPx3, n = 235; BEPx4, n = 82). Incidence of at least 3 AHOs was lowest in surgery-only TCS and increased with BEPx3, BEPx4, and other cisplatin-based regimens (12.2%, 40.8%, 52.5%, 54.8%; P < .0001). Multivariable modeling assessed associations of risk factors and treatment with hearing impairment, tinnitus, peripheral neuropathy, and Raynaud phenomenon. Risk for each AHO statistically increased with both increasing chemotherapy burden (P < .0001) and selected modifiable risk factors (P < .05): hypertension (odds ratio [OR] = 2.40) and noise exposure (OR ≥ 2.3) for hearing impairment; noise exposure for tinnitus (OR ≥ 1.69); peripheral vascular disease for neuropathy (OR = 8.72); and current smoking for Raynaud phenomenon (OR = 2.41). Clinicians should manage modifiable risk factors for AHOs among TCS.
Highlights
Our study investigates for the first time the prevalence and risk factors for chemotherapy-related adverse health outcome (AHO) in U.S testicular cancer survivors (TCS), with surgery-only patients as the control group
Since cisplatin-based chemotherapy was introduced in the 1970s [2], the overall 5-year relative survival rate is over 95% [3]
Fewer TCS had ≥3 AHOs after surgery-only (12.2%) than after BEPX3 (40.8%), BEPX4 (52.5%), and OtherPlat (54.8%) (P
Summary
Testicular cancer (TC) is the most common cancer in men aged 18-39 years [1]. Since cisplatin-based chemotherapy was introduced in the 1970s [2], the overall 5-year relative survival rate is over 95% [3]. Our study investigates for the first time the prevalence and risk factors for chemotherapy-related AHOs in U.S TCS, with surgery-only patients as the control group. We provide for the first time estimates of the magnitude of AHOs associated with current chemotherapy in U.S TCS compared with surgery-only patients. This may potentially guide clinical decision-making, such as recommending surgical approaches with primary retroperitoneal lymph node dissection (RPLND) in patients with low-bulk stage II disease in an attempt to avoid chemotherapy-related AHOs. Future studies should address AHO incidence when adjuvant chemotherapy is applied in early stage disease, or in guiding decisions regarding primary RPLND vs chemotherapy in early stage II disease. NOTES Conflicts of Interest: The authors of this study do not have any conflicts of interest to disclose in the subject matter or materials discussed in this manuscript
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