P–041 Reproductive concerns and sexual health in men with newly diagnosed testicular cancer prior to orchiectomy: preliminary results from an on-going study
Authors: Hoejris N F , Frederiksen Y , Nielsen S H , Brand S L , Holt M , Amidi A , Knudsen U B 
Published: August 2021

Abstract

Study question
What is the prevalence of reproductive concerns among patients with newly diagnosed testicular cancer (TC), and how do they rate their sexual health (SH).

Summary answer
Of 20 patients, 75% (n = 15) were moderate to highly concerned about decreased reproductive functioning. Twenty-four percent exhibited overall low SH.

What is known already
Currently, only little is known about reproductive concerns among TC patients. Furthermore, these concerns have not been investigated in a TC population prior to orchiectomy. One study among post-surgery TC patients two years after diagnosis, reported that 28% had high degree of reproductive concern. The literature indicates that TC patients’ sexual health is negatively affected due to altered body image and sexual dysfunction. However, studies regarding sexual health have primarily been performed on long term survivors of TC. Thus, little is known about SH in this population prior to treatment.

Study design, size, duration
The present cross-sectional study included patients from the fertility clinic in Horsens, Denmark. Patients were approached at their pre-scheduled appointment for cryopreservation of semen prior to orchiectomy. Enrolment started March, 2019 and is still on-going. Preliminary data is included from 21 enrolled patients.

Participants/materials, setting, methods
Patients newly diagnosed with TC, who were referred to the fertility clinic for semen cryopreservation prior to orchiectomy and other treatment modalities were invited. The patients responded to a questionnaire package of which reproductive concerns were assessed with seven questions with Likert scale response options ranging from 0 (not concerned) to 5 (highly concerned). SH was assessed with the validated 22-item questionnaire European Organization for Research and Treatment of Cancer Sexual health questionnaire (EORTC-SHQ).

Main results and the role of chance
A total of 37 patients met the inclusion criteria and of these 21 were enrolled in the study. Due to technical issues, only 20 out of 21 patients completed the full questionnaire package. Patients were asked about concerns regarding the ability to father children. Nine patients (45%) were moderately concerned, and six patients (30%) were highly concerned. When asked about their concerns of not being able to father children without fertility treatment, the answers were mostly unaffected with eight patients (40%) being moderately concerned, and seven patients (35%) highly concerned.
Four patients (20%) were highly concerned that decreased semen quality would affect future or present relationships. Patients were also asked if they felt sufficiently informed regarding the chance of fathering children without help from a fertility clinic following cancer treatment. Three patients (15%) reported that they were insufficiently informed, while four patients (20%) responded only to a little extend. Five patients (23,8%) scored ≤ 50 on the EORTC SHQ indicating that they had low SH. Eleven patients (52,3%) felt less masculine due to their disease. Furthermore, one patient (4,8%) scored ≤ 50 on the symptomatic scale, indicating that he had symptomatic sexual problems as fatigue and sexual pain.

Limitations, reasons for caution
The relatively low participant number is a limitation, making the results less generalizable. Furthermore, there is a risk of selection bias due to the moderate inclusion rate. Also, the questionnaire examining fertility related concerns were non validated, and focused mainly on the fertility-related aspects of reproductive concerns.
Wider implications of the findings: A considerable number of patients with newly diagnosed TC show substantial reproductive concerns as well as lowered sexual health. These worries could possibly be alleviated by more sufficient information from the health professionals already in the beginning of the treatment phase, reducing further emotional distress during the remaining treatment period.

Trial registration number
ClinicalTrials.gov ID:NCT03880994