Adverse Health Outcomes in Relationship to Hypogonadism After Chemotherapy: A Multicenter Study of Testicular Cancer Survivors.
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Date
2019-05-01ICR Author
Author
Abu Zaid, M
Dinh, PC
Monahan, PO
Fung, C
El-Charif, O
Feldman, DR
Hamilton, RJ
Vaughn, DJ
Beard, CJ
Cook, R
Althouse, S
Ardeshir-Rouhani-Fard, S
Sesso, HD
Huddart, R
Mushiroda, T
Kubo, M
Dolan, ME
Einhorn, LH
Fossa, SD
Travis, LB
Platinum Study Group,
Type
Journal Article
Metadata
Show full item recordAbstract
BACKGROUND: This study examined the prevalence of hypogonadism, its clinical and genetic risk factors, and its relationship to adverse health outcomes (AHOs) in North American testicular cancer survivors (TCS) after modern platinum-based chemotherapy. PATIENTS AND METHODS: Eligible TCS were <55 years of age at diagnosis and treated with first-line platinum-based chemotherapy. Participants underwent physical examinations and completed questionnaires regarding 15 AHOs and health behaviors. Hypogonadism was defined as serum testosterone levels ≤3.0 ng/mL or use of testosterone replacement therapy. We investigated the role of 2 single nucleotide polymorphisms (rs6258 and rs12150660) in the sex hormone-binding globulin (SHBG) locus implicated in increased hypogonadism risk in the general population. RESULTS: Of 491 TCS (median age at assessment, 38.2 years; range, 18.7-68.4 years), 38.5% had hypogonadism. Multivariable binary logistic regression analysis identified hypogonadism risk factors, including age at clinical evaluation (odds ratio [OR], 1.42 per 10-year increase; P= .006) and body mass index of 25 to <30 kg/m2 (OR, 2.08; P= .011) or ≥30 kg/m2 (OR, 2.36; P= .005) compared with <25 kg/m2. TCS with ≥2 risk alleles for the SHBG SNPs had a marginally significant increased hypogonadism risk (OR, 1.45; P= .09). Vigorous-intensity physical activity appeared protective (OR, 0.66; P= .07). Type of cisplatin-based chemotherapy regimen and socioeconomic factors did not correlate with hypogonadism. Compared with TCS without hypogonadism, those with hypogonadism were more likely to report ≥2 AHOs (65% vs 51%; P= .003), to take medications for hypercholesterolemia (20.1% vs 6.0%; P<.001) or hypertension (18.5% vs 10.6%; P= .013), and to report erectile dysfunction (19.6% vs 11.9%; P= .018) or peripheral neuropathy (30.7% vs 22.5%; P= .041). A marginally significant trend for increased use of prescription medications for either diabetes (5.8% vs 2.6%; P= .07) or anxiety/depression (14.8% vs 9.3%; P= .06) was observed. CONCLUSIONS: At a relatively young median age, more than one-third of TCS have hypogonadism, which is significantly associated with increased cardiovascular disease risk factors, and erectile dysfunction. Providers should screen TCS for hypogonadism and treat symptomatic patients.
Collections
Subject
Platinum Study Group
Humans
Testicular Neoplasms
Hypogonadism
Antineoplastic Combined Chemotherapy Protocols
Neoplasm Staging
Odds Ratio
Risk Factors
Adolescent
Adult
Aged
Middle Aged
Male
Genetic Variation
Young Adult
Patient Outcome Assessment
Patient Reported Outcome Measures
Cancer Survivors
Research team
Clinical Academic Radiotherapy (Huddart)
Language
eng
Date accepted
2018-11-21
License start date
2019-05
Citation
Journal of the National Comprehensive Cancer Network : JNCCN, 2019, 17 (5), pp. 459 - 468
Publisher
HARBORSIDE PRESS