Impact of pain and adverse health outcomes on long-term US testicular cancer survivors.

Dinh PC, Monahan PO, Fosså SD, Sesso HD, Feldman DR, Dolan ME, Nevel K, Kincaid J, Vaughn DJ, Martin NE, Sanchez VA, Einhorn LH, Frisina R, Fung C, Kroenke K, Travis LB. Impact of pain and adverse health outcomes on long-term US testicular cancer survivors. Journal of the National Cancer Institute. 2024 Mar 7; 116(3):455-467.

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Abstract:

BACKGROUND: No study has quantified the impact of pain and other adverse health outcomes on global physical and mental health in long-term US testicular cancer survivors or evaluated patient-reported functional impairment due to pain. METHODS: Testicular cancer survivors given cisplatin-based chemotherapy completed validated surveys, including Patient-Reported Outcomes Measurement Information System v1.2 global physical and mental health, Patient-Reported Outcomes Measurement Information System pain questionnaires, and others. Multivariable linear regression examined relationships between 25 adverse health outcomes with global physical and mental health and pain-interference scores. Adverse health outcomes with a ß^ ?of more than?2 are clinically important and reported below. RESULTS: Among 358 testicular cancer survivors (median age = 46 years, interquartile range [IQR] = 38-53 years; median time since chemotherapy = 10.7?years, IQR? = 7.2-16.0 years), median adverse health outcomes number was 5 (IQR? = 3-7). A total of 12% testicular cancer survivors had 10 or more adverse health outcomes, and 19% reported chemotherapy-induced neuropathic pain. Increasing adverse health outcome numbers were associated with decreases in physical and mental health (P? < .0001 each). In multivariable analyses, chemotherapy-induced neuropathic pain (ß^ = -3.72; P? = .001), diabetes (ß^ = -4.41; P? = .037), obesity (ß^ = -2.01; P? = .036), and fatigue (ß^ = -8.58; P? < .0001) were associated with worse global mental health, while being married or living as married benefited global mental health (ß^? = 3.63; P? = .0006). Risk factors for pain-related functional impairment included lower extremity location (ß^? = 2.15; P? = .04) and concomitant peripheral artery disease (ß^? = 4.68; P? < .001). Global physical health score reductions were associated with diabetes (ß^ = -3.81; P? = .012), balance or equilibrium problems (ß^ = -3.82; P? = .003), cognitive dysfunction (ß^ = -4.43; P? < .0001), obesity (ß^ = -3.09; P? < .0001), peripheral neuropathy score (ß^ = -2.12; P? < .0001), and depression (ß^ = -3.17; P? < .0001). CONCLUSIONS: Testicular cancer survivors suffer adverse health outcomes that negatively impact long-term global mental health, global physical health, and pain-related functional status. Clinically important factors associated with worse physical and mental health identify testicular cancer survivors requiring closer monitoring, counseling, and interventions. Chemotherapy-induced neuropathic pain must be addressed, given its detrimental impact on patient-reported functional status and mental health 10 or more years after treatment.