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Cumulative Burden of Morbidity Among Testicular Cancer Survivors After Standard Cisplatin-Based Chemotherapy: A Multi-Institutional Study.

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Date
2018-05
ICR Author
Huddart, Robert
Author
Kerns, SL
Fung, C
Monahan, PO
Ardeshir-Rouhani-Fard, S
Abu Zaid, MI
Williams, AM
Stump, TE
Sesso, HD
Feldman, DR
Hamilton, RJ
Vaughn, DJ
Beard, C
Huddart, RA
Kim, J
Kollmannsberger, C
Sahasrabudhe, DM
Cook, R
Fossa, SD
Einhorn, LH
Travis, LB
Platinum Study Group
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Type
Journal Article
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Abstract
Purpose In this multicenter study, we evaluated the cumulative burden of morbidity (CBM) among > 1,200 testicular cancer survivors and applied factor analysis to determine the co-occurrence of adverse health outcomes (AHOs). Patients and Methods Participants were ≤ 55 years of age at diagnosis, finished first-line chemotherapy ≥ 1 year previously, completed a comprehensive questionnaire, and underwent physical examination. Treatment data were abstracted from medical records. A CBM score encompassed the number and severity of AHOs, 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 AHOs co-occurred. Results Among 1,214 participants, approximately 20% had a high (15%) or very high/severe (4.1%) CBM score, whereas approximately 80% scored medium (30%) or low/very low (47%). Increased risks of higher scores were associated with four cycles of either ifosfamide, etoposide, and cisplatin (odds ratio [OR], 1.96; 95% CI, 1.04 to 3.71) or bleomycin, etoposide, and cisplatin (OR, 1.44; 95% CI, 1.04 to 1.98), older attained age (OR, 1.18; 95% CI, 1.10 to 1.26), current disability leave (OR, 3.53; 95% CI, 1.57 to 7.95), less than a college education (OR, 1.44; 95% CI, 1.11 to 1.87), and current or former smoking (OR, 1.28; 95% CI, 1.02 to 1.63). CBM score did not differ after either chemotherapy regimen ( P = .36). Asian race (OR, 0.41; 95% CI, 0.23 to 0.72) and vigorous exercise (OR, 0.68; 95% CI, 0.52 to 0.89) were protective. Variable clustering analyses identified six significant AHO clusters (χ2 P < .001): hearing loss/damage, tinnitus (OR, 16.3); hyperlipidemia, hypertension, diabetes (OR, 9.8); neuropathy, pain, Raynaud phenomenon (OR, 5.5); cardiovascular and related conditions (OR, 5.0); thyroid disease, erectile dysfunction (OR, 4.2); and depression/anxiety, hypogonadism (OR, 2.8). Conclusion Factors associated with higher CBM may identify testicular cancer survivors in need of closer monitoring. If confirmed, identified AHO clusters could guide the development of survivorship care strategies.
URI
https://repository.icr.ac.uk/handle/internal/1672
DOI
https://doi.org/10.1200/JCO.2017.77.0735
Collections
  • Radiotherapy and Imaging
Subject
Platinum Study Group
Humans
Neoplasms, Germ Cell and Embryonal
Testicular Neoplasms
Cisplatin
Antineoplastic Combined Chemotherapy Protocols
Physical Examination
Exercise
Severity of Illness Index
Factor Analysis, Statistical
Risk Factors
Health Status
Adult
Middle Aged
Male
Surveys and Questionnaires
Long Term Adverse Effects
Cancer Survivors
Research team
Clinical Academic Radiotherapy (Huddart)
Language
eng
Date accepted
2018-02-02
License start date
2018-05
Citation
Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2018, 36 (15), pp. 1505 - 1512

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