Long-term quality of life of testicular cancer patients differs according to applied adjuvant treatment and tumour type
Authors: Heinzelbecker Julia , Kaßmann Karla , Ernst Simone , Meyer-Mabileau Pia , Germanyuk Aleksandra , Zangana Miran , Wagenpfeil Gudrun , Ohlmann Carsten H. , Cohausz Maximilian , Stöckle Michael , Lehmann Jan 
Published: February 2024

Purpose
To evaluate quality of life (QoL) in long-term testicular cancer (TC) survivors.
Methods
QoL was assessed in TC patients treated between March 1975 and December 2004 using the EORTC-QLQ-C30 questionnaire, including a TC module. Assessment was performed at two time points (2006: n = 201/625 (32.2%), median FU: 12.9 y (1.1–30.9); 2017: 91/201 (45.3%), median FU: 26.2 y (13.0-41.2)). Patients were grouped according to treatment strategy, tumour entity, clinical stage and prognosis group. Linear and multiple linear regression analyses were performed, with age and time of follow-up as possible confounders.
Results
Radiation therapy (RT), compared to retroperitoneal lymph node dissection (RPLND), was associated with significantly higher impairment of global QoL, as well as physical, role and emotional function; fatigue; nausea; pain; insomnia; appetite loss; constipation; and poor body image. When correcting for age and time of follow-up, only physical function (2017: β= -9.038; t(84)= -2.03; p = 0.045), role function (2017: β= -12.764; t(84)= -2.00; p = 0.048), emotional function (2006: β= -9.501; t(183)= -2.09; p = 0.038) and nausea (2006: β = 6.679; t(185) = 2.70; p = 0.008) remained statistically significant. However, RT was associated with a lower impairment of sexual enjoyment (2017: symptoms: β = 26.831; t(64) = 2.66; p = 0.010; functional: β = 22.983; t(65): 2.36; p = 0.021). Chemotherapy (CT), compared to RPLND, even after correction, was associated with a higher impairment of role (2017: β= -16.944; t(84)= -2.62; p = 0.011) and social function (2017: β= -19.160; t(79)= -2.56; p = 0.012), more insomnia (2017: β = 19.595; t(84) = 2.25; p = 0.027) and greater concerns about infertility (2017: β = 19.830; t(80) = 2.30; p = 0.024). In terms of tumour type, nonseminomatous germ cell tumour (NSGCT) compared to seminoma patients had significantly lower impairment of global QoL and physical and emotional function; less appetite loss, dyspnoea, pain and nausea; better future perspective; body image problems and greater treatment satisfaction. However, after correction, only nausea (2006: β= -4.659; t(187)= -2.17; p = 0.031), appetite loss (2006: β= -7.554; t(188)= -2.77; p = 0.006) and future perspective (2006: β= -12.146; t(175)= -2.08; p = 0.039) remained statistically significant. On the other hand, NSGCT was associated with higher impairment in terms of sexual problems (2006: β = 16.759; t(145) = 3.51; p < 0.001; 2017: β = 21.207; t(63) = 2.73; p = 0.008) and sexual enjoyment (2017: β= -24.224; t(66)= -2.76; p = 0.008).
Conclusions
The applied adjuvant treatment and the tumour entity had a significant impact on the long-term QoL of TC survivors. Both radio- and chemotherapy had a negative impact compared to patients treated with RPLND, except for on sexual concerns. NSGCT patients had a lower impairment of QoL compared to seminoma patients, except in terms of sexual concerns.
Implications for Cancer Survivors:
The aims of the study were to raise awareness of aspects of long-term and late effects on quality of life in TC survivors; offer supportive care, such as psycho-oncological support or lifestyle modification, if a deterioration in quality of life is noticed; and avoid toxic treatment opportunities without compromising a cure whenever possible.