Which patients are at risk for poorer outcomes from testicular cancer (TC) and its treatment?

Abstract

e24060 Background: TC is a highly treatable disease with a 5-year combined relative survival rate of 95%. Survival, however, can come at a price, and longer-term negative physical and psychosocial sequelae have been described in the literature. We examined unmet needs and psychological and physical well-being in a sample of TC survivors attending a survivorship visit with the aim of describing the outcomes achieved and identifying characteristics of individuals most at risk of poor outcomes. Methods: Patients attending a survivorship clinic visit completed measures assessing 13 common physical and psychosocial needs, anxiety and depression (HADS), and QoL (SF-12V2). These data were described, subjected to hierarchical cluster analysis, and the resulting clusters were examined for disease, treatment, and demographic differences. Results: Participants (N = 312) from the same institution were primarily white (94%), non-Hispanic (98%), middle-aged (M = 42.8, SD = 11.1), married (74%), college graduates (79%), making more than $80,000/year (72%). On average, participants were diagnosed 9.8 (SD = 6.5) years earlier, though that ranged from 2-44 years, with Stage I or II TC (80%) that required surgery (99%) including RPLND (22%), chemotherapy (50%), and/or radiation (12%). Unmet needs were generally low (M = 0.91, SD = 2.1, R = 0-13) with 72% reporting no unmet need, and no unmet need was endorsed at a rate higher than 10%. Depressive symptoms were uncommon (HADS-D M = 2.3 SD = 2.6) with 95% classified as having no depressive symptoms. Symptoms of anxiety were more common (HADS-A M = 4.9; SD = 3.7) although 78% were classified as having no symptoms. QoL was similar to population norm values (M = 50) for both mental (M = 51.8) and physical (M = 51.7) well-being. Hierarchical cluster analysis of unmet needs, anxiety and depressive symptoms, and QoL revealed 2 distinct groups, one (86%) experiencing more positive outcomes than the other (14%). These groups differed significantly in unmet needs (M's 0.5 vs. 3.3), anxiety (M's 3.9 vs. 10.6) and depressive symptoms (M's 1.6 vs. 6.3), and mental QoL (M's 54.4 vs. 34.3; all p's < 0.001). Groups did not differ with respect to physical well-being (M's 51.4 vs. 53.2, ns). Individuals in the less well-functioning group were more likely to have been diagnosed with Stage 3 disease, be unmarried, and have a lower income (all p < 0.05). Treatment intensity, educational attainment, age, and time from diagnosis were not significantly associated with group membership. Conclusions: Most TC survivors report good functioning with few unmet needs and low levels of anxiety and depression during survivorship. A minority of TC survivors, however, experience substantially greater psychosocial but not physical difficulties, and these individuals are likely to be unmarried, have lower income, and been initially diagnosed with more advanced disease.