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Adverse Health Outcomes Among US Testicular Cancer Survivors After Cisplatin-Based Chemotherapy vs Surgical Management.

Agrawal V, Dinh PC, Fung C, Monahan PO, Althouse SK, Norton K, Cary C, Einhorn L, Fossa SD, Adra N, Travis LB. Adverse Health Outcomes Among US Testicular Cancer Survivors After Cisplatin-Based Chemotherapy vs Surgical Management. JNCI cancer spectrum. 2020 Apr 1; 4(2):pkz079.

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Abstract:

We evaluated for the first time, to our knowledge, adverse health outcomes (AHOs) among US testicular cancer survivors (TCS) given chemotherapy (n? = 381) vs surgery-only patients (n? = 98) managed at a single institution, accounting for non-treatment-related risk factors to delineate chemotherapy's impact. Chemotherapy consisted largely of bleomycin-etoposide-cisplatin (BEP) administered in three or four cycles (BEPx3, n? = 235; BEPx4, n? = 82). Incidence of at least 3 AHOs was lowest in surgery-only TCS and increased with BEPx3, BEPx4, and other cisplatin-based regimens (12.2%, 40.8%, 52.5%, 54.8%; < .0001). Multivariable modeling assessed associations of risk factors and treatment with hearing impairment, tinnitus, peripheral neuropathy, and Raynaud phenomenon. Risk for each AHO statistically increased with both increasing chemotherapy burden (? < .0001) and selected modifiable risk factors (? < .05): hypertension (odds ratio [OR]? = 2.40) and noise exposure (OR? = 2.3) for hearing impairment; noise exposure for tinnitus (OR? = 1.69); peripheral vascular disease for neuropathy (OR? = 8.72); and current smoking for Raynaud phenomenon (OR? = 2.41). Clinicians should manage modifiable risk factors for AHOs among TCS.




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