Cumulative burden of morbidity among testicular cancer survivors after standard cisplatin-based chemotherapy: A multi-institutional study Journal Article


Authors: Kerns, S. L.; Fung, C.; Monahan, P. O.; Ardeshir-Rouhani-Fard, S.; Abu Zaid, M. I.; Williams, A. M.; Stump, T. E.; Sesso, H. D.; Feldman, D. R.; Hamilton, R. J.; Vaughn, D. J.; Beard, C.; Huddart, R. A.; Kim, J.; Kollmannsberger, C.; Sahasrabudhe, D. M.; Cook, R.; Fossa, S. D.; Einhorn, L. H.; Travis, L. B.; for the Platinum Study Group
Contributors: Jacobsen, E.; Silber, D.; Bosl, G.
Article Title: Cumulative burden of morbidity among testicular cancer survivors after standard cisplatin-based chemotherapy: A multi-institutional study
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 (x2 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. © 2018 by American Society of Clinical Oncology.
Journal Title: Journal of Clinical Oncology
Volume: 36
Issue: 15
ISSN: 0732-183X
Publisher: American Society of Clinical Oncology  
Date Published: 2018-05-20
Start Page: 1505
End Page: 1512
Language: English
DOI: 10.1200/jco.2017.77.0735
PROVIDER: scopus
PUBMED: 29617189
DOI/URL:
Notes: Article -- Export Date: 1 June 2018 -- Source: Scopus
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MSK Authors
  1. Darren Richard Feldman
    164 Feldman
  2. George Bosl
    250 Bosl
  3. Deborah Scaler Silber
    3 Silber