Multi-Institutional Assessment of Adverse Health Outcomes Among North American Testicular Cancer Survivors After Modern Cisplatin-Based Chemotherapy

J Clin Oncol. 2017 Apr 10;35(11):1211-1222. doi: 10.1200/JCO.2016.70.3108. Epub 2017 Feb 27.

Abstract

Purpose To provide new information on adverse health outcomes (AHOs) in testicular cancer survivors (TCSs) after four cycles of etoposide and cisplatin (EPX4) or three or four cycles of bleomycin, etoposide, cisplatin (BEPX3/BEPX4). Methods Nine hundred fifty-two TCSs > 1 year postchemotherapy underwent physical examination and completed a questionnaire. Multinomial logistic regression estimated AHOs odds ratios (ORs) in relation to age, cumulative cisplatin and/or bleomycin dose, time since chemotherapy, sociodemographic factors, and health behaviors. Results Median age at evaluation was 37 years; median time since chemotherapy was 4.3 years. Chemotherapy consisted largely of BEPX3 (38.2%), EPX4 (30.9%), and BEPX4 (17.9%). None, one to two, three to four, or five or more AHOs were reported by 20.4%, 42.0%, 25.1%, and 12.5% of TCSs, respectively. Median number after EPX4 or BEPX3 was two (range, zero to nine and zero to 11, respectively; P > .05) and two (range, zero to 10) after BEPX4. When comparing individual AHOs for EPX4 versus BEPX3, Raynaud phenomenon (11.6% v 21.4%; P < .01), peripheral neuropathy (29.2% v 21.4%; P = .02), and obesity (25.5% v 33.0%; P = .04) differed. Larger cumulative bleomycin doses (OR, 1.44 per 90,000 IU) were significantly associated with five or more AHOs. Increasing age was a significant risk factor for one to two, three to four, or five or more AHOs versus zero AHOs (OR, 1.22, 1.50, and 1.87 per 5 years, respectively; P < .01); vigorous physical activity was protective (OR, 0.62, 0.51, and 0.41, respectively; P < .05). Significant risk factors for three to four and five or more AHOs included current (OR, 3.05 and 3.73) or former (OR, 1.61 and 1.76) smoking ( P < .05). Self-reported health was excellent/very good in 59.9% of TCSs but decreased as AHOs increased ( P < .001). Conclusion Numbers of AHOs after EPX4 or BEPX3 appear similar, with median follow-up of 4.3 years. A healthy lifestyle was associated with reduced number of AHOs.

Publication types

  • Multicenter Study

MeSH terms

  • Adult
  • Age Factors
  • Aged
  • Antineoplastic Combined Chemotherapy Protocols / administration & dosage
  • Antineoplastic Combined Chemotherapy Protocols / adverse effects*
  • Bleomycin / administration & dosage
  • Bleomycin / adverse effects
  • Canada / epidemiology
  • Case-Control Studies
  • Cisplatin / administration & dosage
  • Cisplatin / adverse effects
  • Etoposide / administration & dosage
  • Exercise
  • Health Status
  • Hearing Loss / chemically induced
  • Hearing Loss / epidemiology
  • Humans
  • Long Term Adverse Effects / chemically induced
  • Long Term Adverse Effects / epidemiology
  • Male
  • Middle Aged
  • Obesity / chemically induced
  • Obesity / epidemiology*
  • Peripheral Nervous System Diseases / chemically induced
  • Peripheral Nervous System Diseases / epidemiology*
  • Prevalence
  • Protective Factors
  • Raynaud Disease / chemically induced
  • Raynaud Disease / epidemiology*
  • Risk Factors
  • Smoking / epidemiology
  • Surveys and Questionnaires
  • Survivors / statistics & numerical data*
  • Testicular Neoplasms / drug therapy*
  • Tinnitus / chemically induced
  • Tinnitus / epidemiology
  • United States / epidemiology
  • Young Adult

Substances

  • Bleomycin
  • Etoposide
  • Cisplatin