Testicular cancer is diagnosed at a young age and survival rates are high; thus, the long-term effects of cancer treatment need to be assessed. Our objectives are to estimate the incidence rates and determinants of late effects in testicular cancer survivors.
We conducted a population-based cohort study of testicular cancer survivors, diagnosed 1991–2007, followed up for a median of 10 years. We identified 785 testicular cancer patients who survived ≥5 years and 3323 men free of cancer for the comparison group. Multivariate Cox regression analysis was used to compare the hazard ratio between the cases and the comparison group and for internal analysis among case patients.
Testicular cancer survivors experienced a 24 % increase in risk of long-term health effects >5 years after diagnosis. The overall incidence rate of late effects among testicular cancer survivors was 66.3 per 1000 person years. Higher risks were observed among testicular cancer survivors for hypercholesterolemia, infertility, and orchitis. Chemotherapy and retroperitoneal lymph node dissection appeared to increase the risk of late effects. Being obese prior to cancer diagnosis appeared to be the strongest factor associated with late effects.
Testicular cancer survivors were more likely to develop chronic health conditions when compared to cancer-free men.
Implications for Cancer Survivors
While the late effects risk was increased among testicular cancer survivors, the incidence rates of late effects after cancer diagnosis was fairly low.
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American Cancer Society. Cancer treatment and survivorship facts and figures, 2014–2015. Atlanta: American Cancer Society; 2014.
Ferlay J SHR, Bray F, Forman D, Mathers C, Parkin DM. GLOBOCAN 2008 v2.0, Cancer incidence and mortality worldwide: IARC CancerBase No. 10, http://globocan.iarc.fr.
Fast Stats: an interactive tool for access to SEER cancer statistics. Surveillance Research Program, National Cancer Institute. http://seer.cancer.gov/faststats. 2013.
Purdue MP, Devesa SS, Sigurdson AJ, McGlynn KA. International patterns and trends in testis cancer incidence. Int J Cancer. 2005;115(5):822–7.
Ries LAG YJL, Keel GE, Eisner MP, Lin YD, Horner M-J. SEER Survival monograph: cancer survival among adults: U.S. SEER Program, 1988–2001, Patient and Tumor Characteristics. National Cancer Institute, SEER Program, NIH Pub. No. 07-6215, Bethesda, MD 2007.
Haugnes HS, Bosl GJ, Boer H et al. Long-term and late effects of germ cell testicular cancer treatment and implications for follow-up. J Clin Oncol. 2012; 30(1527-7755 (Electronic))(0732-183X (Linking))(30), 3752–3763.
Covielle VBM. Cumulative incidence estimation in the presence of competing risks. STATA. 2004;4(2):103–12.
Crowther M.J. LPC. stgenreg: A Stata package for general parametric survival analysis. J Stat. Soft. 2013; 53(12):1–17.
Meinardi MT, Gietema JA, van Veldhuisen DJ, van der Graaf WT, de Vries EG, Sleijfer DT. Long-term chemotherapy-related cardiovascular morbidity. Cancer Treat Rev. 2000;26(6):429–47.
van den Belt-Dusebout AW, Nuver J, de Wit R, et al. Long-term risk of cardiovascular disease in 5-year survivors of testicular cancer. J Clin Oncol. 2006;24(3):467–75.
Huddart RA, Norman A, Shahidi M, et al. Cardiovascular disease as a long-term complication of treatment for testicular cancer. J Clin Oncol. 2003;21(8):1513–23.
Haugnes HS, Wethal T, Aass N, et al. Cardiovascular risk factors and morbidity in long-term survivors of testicular cancer: a 20-year follow-up study. J Clin Oncol. 2010;28(30):4649–57.
Centers for Disease Control and Prevention (CDC). Behavioral risk factor surveillance system survey data. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention; 2014.
NCCN Clinical Practice Guidelines in Oncology: Testicular Cancer 1.2013. National Comprehensive Cancer Network, 2013.
Beard CJ, Travis LB, Chen MH, et al. Outcomes in stage I testicular seminoma: a population-based study of 9193 patients. Cancer. 2013;119(15):2771–7.
Willemse PM, Burggraaf J, Hamdy NA, et al. Prevalence of the metabolic syndrome and cardiovascular disease risk in chemotherapy-treated testicular germ cell tumour survivors. Br J Cancer. 2013;109(1):60–7.
Gietema JA, Sleijfer DT, Willemse PH et al. Long-term follow-up of cardiovascular risk factors in patients given chemotherapy for disseminated nonseminomatous testicular cancer. Ann Intern Med. 1992; 116(0003-4819 (Print))(0003-4819 (Linking))(9), 709–715.
Meinardi MT, Gietema JA, van dG,WT, et al. Cardiovascular morbidity in long-term survivors of metastatic testicular cancer. J Clin Oncol. 2000; 18(0732-183X (Print))(0732-183X (Linking))(8), 1725–1732.
Haugnes HS, Aass N, Fossa SD, et al. Components of the metabolic syndrome in long-term survivors of testicular cancer. Ann Oncol. 2007;18(2):241–8.
Feldman DR, Bosl GJ, Sheinfeld J, Motzer RJ. Medical treatment of advanced testicular cancer. JAMA 2008; 299(1538-3598 (Electronic))(0098-7484 (Linking))(6), 672–684.
Glendenning JL, Barbachano Y, Norman AR, Dearnaley DP, Horwich A, Huddart RA. Long-term neurologic and peripheral vascular toxicity after chemotherapy treatment of testicular cancer. Cancer. 2010;116(10):2322–31.
Rossen PB, Pedersen AF, Zachariae R, von der Maase H. Health-related quality of life in long-term survivors of testicular cancer. J Clin Oncol. 2009;27(35):5993–9.
Oldenburg J, Fossa SD, Dahl AA. Scale for chemotherapy-induced long-term neurotoxicity (SCIN): psychometrics, validation, and findings in a large sample of testicular cancer survivors. Qual Life Res. 2006;15(5):791–800.
Brydoy M, Oldenburg J, Klepp O, et al. Observational study of prevalence of long-term Raynaud-like phenomena and neurological side effects in testicular cancer survivors. J Natl Cancer Inst. 2009;101(24):1682–95.
This work was supported by a grant from the National Cancer Institute at the National Institutes of Health (grant number R03 159357). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Cancer Institute or the National Institutes of Health.
Partial support for all datasets within the Utah Population Database was provided by the University of Utah Huntsman Cancer Institute and the Huntsman Cancer Institute Cancer Center Support grant, P30 CA2014 from the National Cancer Institute. Research was supported by the Utah Cancer Registry, which is funded by Contract No. HHSN261201000026C from the National Cancer Institute’s SEER Program with additional support from the Utah State Department of Health and the University of Utah.
This study was supported by a grant from the National Cancer Institute at the National Institutes of Health (grant number R03 159357).
Conflict of interest
The authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
The study used secondary data and did not involve any contact of participants. We obtained a waiver of consent for all individual participants included in the study with our IRB.
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Hashibe, M., Abdelaziz, S., Al-Temimi, M. et al. Long-term health effects among testicular cancer survivors. J Cancer Surviv 10, 1051–1057 (2016). https://doi.org/10.1007/s11764-016-0548-1
- Testicular cancer
- Late effects
- Cardiovascular disease