Journal of Cancer Survivorship

, Volume 7, Issue 3, pp 404-412

First online:

Potential gonadotoxicity of treatment in relation to quality of life and mental well-being of male survivors of childhood acute lymphoblastic leukemia

  • Mirja Erika GunnAffiliated withDepartment of Pediatrics, Turku University Hospital
  • , Päivi Maria LähteenmäkiAffiliated withDepartment of Pediatrics, Turku University Hospital Email author 
  • , Leena-Riitta Puukko-ViertomiesAffiliated withDepartment of Adolescent Psychiatry, Helsinki University Hospital
  • , Markus HenrikssonAffiliated withNational Supervisory Authority for Welfare and HealthCentre for Military Medicine, Finnish Defence Forces
  • , Risto HeikkinenAffiliated withDepartment of Adolescent Psychiatry, Helsinki University Hospital
  • , Kirsi JahnukainenAffiliated withDivision of Hematology–Oncology and Stem Cell Transplantation, Children´s Hospital, University of Helsinki and Helsinki University Central HospitalDepartment of Women’s and Children’s Health, Karolinska Institute and University Hospital

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Results of earlier studies concerning quality of life (QOL) and psychosocial coping of childhood acute lymphoblastic leukemia (ALL) survivors have been inconsistent. Some treatments for ALL affect testicular function and we hypothesized that this may influence the QOL and psychosocial coping of male survivors. Our aims were to assess the QOL and psychosocial coping of male long-term ALL survivors and to evaluate the effect of both testosterone level and the potential gonadotoxicity of various treatment modalities on them.


Fifty-two male long-term survivors treated for childhood ALL at Helsinki University Hospital between 1970 and 1995, and 56 age- and gender-matched controls were studied. The participants completed a self-report questionnaire including questions on sociodemographics, RAND-36 to assess QOL, General Health Questionnaire and Beck Depression Inventory to assess mental well-being, and CAGE to assess alcohol abuse/dependence. Testosterone levels were measured, and treatment details were reviewed.


ALL survivors in general had QOL close to that of controls or population norms. Decreased QOL was seen in physical health-related subscales, and vitality and emotional well-being were lowered in survivors with more gonadotoxic treatment modalities. No single independent factor in the treatment or the level of testosterone could, however, be found to clearly explain the variation in QOL scores of the survivors. Mental well-being of most of the survivors was good, but a subgroup with previous cyclophosphamide treatment or testicular irradiation showed increased risk of psychiatric morbidity.


The male ALL survivors generally cope well, but increased focus on specific risk groups seems to be necessary. Further studies using patient interviews would probably point out issues concerning the QOL and psychosocial coping of ALL survivors, which may not emerge in these screening studies.

Implications for Cancer Survivors

In general, more attention should be paid for physical functioning of childhood ALL survivors. Increased focus should also be on QOL and mental well-being of survivors with more gonadotoxic treatment modalities and those whose diagnosis was made in their adolescence.


Acute lymphoblastic leukemia Quality of life Psychosocial Adolescent/young adult Survivorship Testicular function