Long-term quality of life of testicular cancer survivors 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: April 2024

Abstract
Purpose
To evaluate the quality of life (QoL) in long-term testicular cancer (TC) survivors.

Methods
QoL was assessed in TC survivors treated between March 1976 and December 2004 (n = 625) using the EORTC-QLQ-C30 questionnaire, including a TC module. The assessment was performed at two time points (2006: response rate: n = 201/625 (32.2%), median follow-up (FU): 12.9 years (range 1.1–30.9); 2017: response rate: n = 95/201 (47.3%), median FU: 26.2 years (range: 13.0–41.2)). TC survivors 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 a higher impairment of 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). 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 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 survivors had significantly lower impairment of 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). On the other hand, surviving 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, even more than 25 years after the completion of therapy. Both RT and CT had a negative impact compared to survivors treated with RPLND, except for sexual concerns. NSGCT survivors had a lower impairment of QoL compared to seminoma survivors, except in terms of sexual concerns.

Implications for Cancer Survivors
Implications for cancer survivors are to raise awareness of aspects of long-term and late effects on QoL in TC survivors; offer supportive care, such as psycho-oncological support or lifestyle modification, if a deterioration in QoL is noticed; and avoid toxic treatment without compromising a cure whenever possible.