Impact of adverse health outcomes (AHOs) on self-reported physical and mental health in U.S. testicular cancer survivors (TCS).
Authors: Dinh Paul C. , Monahan Patrick O. , Clasen Suparna Chandra , Sesso Howard D. , Einhorn Lawrence H. , Fossa Sophie D. , Vaughn David J. , Martin Neil E. , Fung Chunkit , Travis Lois B. 
Published: June 2022

12080

Background: No study has systematically evaluated the impact of AHOs on PROMIS-validated measures of physical and mental health in TCS. Patient-reported outcomes are increasingly recognized as crucial in TCS follow-up, given their young age at diagnosis and high cure rates. Methods: Eligible TCS (age < 60 yr at diagnosis, given first-line cisplatin-based chemotherapy (CHEM)) completed comprehensive health surveys, prescription drug usage, and PROMIS global physical health and global mental health measures. PROMIS scores were compared to US subpopulation norms for similar-age men. 2017-2018 NHANES data were compared with select survey responses. Linear regression examined the relationship between individual AHOs (pain, obesity, cisplatin-induced peripheral neuropathy (CIPN)), cisplatin-related AHOs (CIPN, hearing loss, vertigo, tinnitus, renal disease), cardiovascular (CVD) AHOs (7 AHO), and all AHOs taken together (24 AHOs), with PROMIS global physical and mental health measures. Regression models were adjusted for age, cisplatin dose, time since CHEM, education, income, smoking, and alcohol. Results: Among 213 TCS (median age at evaluation: 46 yr; IQR: 38-52 yr; median time since CHEM completion: 10.6 yr; IQR: 6.8-16.6 yr), the most common AHOs were tinnitus (60%), self-reported hearing loss (60%), CIPN (55%), and Raynaud Phenomenon (43%). The median number of AHOs was 5 (IQR: 3-7), and 12% of TCS had ≥10 AHOs. Only 1.4% of TCS had no AHOs. Compared to NHANES men without cancer, controlling for age, education, and race, fewer TCS currently smoked (3% vs. 22%; P<.001) and fewer were obese (31% vs. 43%, P=.026) but alcohol intake was comparable. However, TCS had significantly lower physical (mean: 48.5 vs. 51.2, P<.001) and mental health (mean: 48.4 vs. 50.8, P<.001) than US men. Increasing numbers of AHOs were significantly associated with decreasing physical ( P<.001) and mental health ( P<.001) after adjustment. The magnitude of effect was strongest for the number of cisplatin-related AHOs with both physical (β: -1.3; 95% CI: -1.9, -0.7; P<.001) and mental health (β: -1.3; 95% CI: -2.1, -0.4; P=.003) after adjustment. In individual AHO adjusted models, CIPN (β: -1.8; 95% CI: -3.3, -0.4), pain (β: -5.0; 95% CI: -6.8, -3.2) and obesity (β: -2.7; 95% CI: -4.3, -1.1) were significantly associated with decreased physical health. Only pain (β: -5.9; 95% CI: -8.4, -3.4) and CIPN (β: -2.0; 95% CI: -4.0, -0.1), but not obesity, were associated with decreased mental health. Conclusions: At a median of 11 years after CHEM completion, 50% of TCS have ≥5 AHOs, and over 1 in 10 have ≥10 AHOs. AHO following cisplatin chemotherapy have major deleterious impacts on patient-reported measures of physical and mental health. Future survivorship research should focus on developing preventive and interventional strategies to care for TCS most vulnerable for impaired physical and mental health after CHEM.