Factors Associated With High Cumulative Burden of Morbidity Among Survivors of Testicular Cancer

Survivors of testicular cancer with factors associated with a high cumulative burden of morbidity score (CBM) may be in need of closer monitoring, according to a study published in the Journal of Clinical Oncology (online: April 4, 2018; doi:10.1200/JCO.2017.77.0735).

Lawrence H Einhorn, MD, school of medicine, Indiana University, and colleagues evaluated the CBM among testicular cancer survivors and applied factor analysis to determine the co-occurrence of adverse health outcomes.

Researchers included a total of 1214 patients in the multicenter study. Participants were 55 years of age or older at diagnosis, finished first-line chemotherapy a year or more prior to the trial initiation, completed a comprehensive questionnaire, and underwent physical examination. Treatment data were abstracted from medical records.

CBM scores encompassed the number and severity of adverse health outcomes, with ordinal logistic regression used to assess associations with exposures. Nonlinear factor analysis and the nonparametric dimensionality evaluation to enumerate contributing traits procedure determined which adverse health outcomes co-occurred.

Dr Einhorn and colleagues noted that among the 1214 patients, approximately 20% had a high or very high/sever CBM score, whereas approximately 80% scored medium or low/very low. Increased risks of higher scores were associated with four cycles of either ifosfamide, etoposide, and cisplatin; bleomycin, etoposide, and cisplatin; older attained age; current disability leave; less than a college education; and current or former smoking.

Additionally, researchers reported CBM score did not differ after either chemotherapy regimen. Asian race and vigorous exercise were protective. Variable clustering analyses identified six significant adverse health outcomes: hearing loss/damage, tinnitus; hyperlipidemia, hypertension, diabetes; neuropathy, pain, Raynaud phenomenon; cardiovascular and related conditions; thyroid disease, erectile dysfunction; and depression/anxiety, hypogonadism.

“Factors associated with higher CBM may identify testicular cancer survivors in need of closer monitoring,” authors of the study concluded. “If confirmed, identified adverse health outcomes clusters could guide the development of survivorship care strategies.”—Janelle Bradley

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