Unmet need, survivorship concerns, and psychosocial outcomes among testicular cancer (TC) survivors.

Abstract

226 Background: Although some aspects of quality of life are well described among TC survivors, particularly in Europe, unmet need for symptom management, degree of survivorship concern, and their relationship to outcomes such as anxiety and depression have been unexplored among TC survivors in the U.S. Methods: Concurrent TC survivors treated > 1 year prior with no evidence of disease were recruited in a U.S. survivorship clinic. Participants completed a measure of 13 unmet needs and a 17-item scale assessing survivorship concern in follow-up care and screening, symptom management, family and genetic issues, and fear of recurrence (0-3 scale, alpha = 0.92). Anxiety and depression were assessed using the HADS. Results: Participants (N = 199) were primarily white (96%), early middle aged (M = 41 yrs), treated for Stage I (81%) or II TC (11%) with surgery (100%), chemotherapy (39%), and/or XRT (14%) an average of 7 years earlier. 11% reported hormone replacement therapy (HRT), and 16% had experienced a relapse. Participants reported an average 1.1 unmet needs (R = 0-11) with 66% reporting none. Unmet needs most commonly focused on fatigue (16%), sexual interest (12%), weight (12%), and concentration (11%) issues. Survivorship concern was low (M = 1.0) but variable (R = 0-2.9). Depressive (M = 2.1) and anxiety symptoms (M = 4.8) were generally low, though elevated in 4% and 19%, respectively. Age, time from diagnosis, race, curative therapy type, and relapse were unrelated to unmet need, concern, anxiety or depression. Higher staging and those receiving HRT was associated with more unmet need (p < 0.04). Unmet needs were associated with concerns (r = .33), anxiety (r = .24), and depression (r = .50). Concerns were associated with anxiety (r = .36) and depression (r = .32). Conclusions: Psychosocial adaptation appears good among most TC survivors, though a substantial number experience elevated anxiety. Survivorship concerns and unmet needs are associated with poorer adaptation in both depression and anxiety symptoms. Assessing and addressing concerns and unmet needs may improve outcomes among TC survivors.