Adverse health outcomes and global quality of life in long-term testicular cancer survivors: a longitudinal 30-year perspective

Abstract

In Testicular Cancer Survivors (TCSs, Diagnosis 1980-1994) to describe the prevalence of self-reported Adverse Health Outcomes (AHOs), AHO changes and their effect on Health-Related Quality of Life (HrQoL), assessed at two survey waves median 12 and 28 years after surgery-only or platinum-based chemotherapy (PBCT)."Typical AHOs" (peripheral sensory neuropathy [PSN], Raynaud phenomena [RP], tinnitus, hearing loss [HL]) were emphasized. 427 TCSs were evaluable: Surgery-Only (n: 155), PBCT-Standard: ≤850 mg cisplatin (n: 222), PBCT-High: >850 mg cisplatin (n: 50). Men from the general population represented a control group (Norms) for HrQoL comparison. Statistical significance level: p <0.05. Clinical importance (for testing HrQoL differences): Δ ≥2.5 points. More TCSs after PBCT than after surgery-only reported typical AHOS, the highest prevalence rates observed after PBCT-High. Further, the number of TCSs describing typical AHOs, except Raynaud phenomena, increased during the observation period of 16 years. At the last survey wave median four AHOs (any type) were reported after PBCT-High compared to median two AHOs after surgery-only or after PBCT-Standard. With surgery-only as reference PBCT-High, but not PBCT-Standard, was at the last survey wave associated with decreasing physical HrQoL (regression coefficient: -4.3; p:0.008 Comparing all TCSs with Norms no clinically important difference of physical and mental HrQoL was observed at either survey wave. However, at the last survey wave TCSs after PBCT- High represented a subgroup with clinically important impairment of HRQoL. Of the typical AHOs only PSN reduced HrQoL. Chronic fatigue, pain, anxiety / depression, sexual dysfunction, unemployment, being single and low education were additional covariates. At a median of 28 years after treatment, HrQoL was similar in Norms and in TCSs, despite increasingly prevalent AHOs, in particular after PBCT-High. Prior PBCT-High identifies TCSs at high-risk of significantly increased prevalence of long-term AHOs and reduced HrQoL, these TCSs requiring particular awareness during life-long follow-up.