| 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 bb of more than 2 are clinically important and reported below. Results: Among 358 testicular cancer survivors (median age 1⁄4 46 years, interquartile range [IQR] 1⁄4 38–53 years; median time since chemotherapy 1⁄4 10.7 years, IQR 1⁄4 7.2–16.0 years), median adverse health outcomes number was 5 (IQR 1⁄4 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 (bb 1⁄4 −3.72; P 1⁄4 .001), diabetes (bb 1⁄4 −4.41; P 1⁄4 .037), obesity (bb 1⁄4 −2.01; P 1⁄4 .036), and fatigue (bb 1⁄4 −8.58; P < .0001) were associated with worse global mental health, while being married or living as married benefited global mental health (bb 1⁄4 3.63; P 1⁄4 .0006). Risk factors for pain-related functional impairment included lower extremity location (bb 1⁄4 2.15; P 1⁄4 .04) and concomitant peripheral artery disease (bb 1⁄4 4.68; P < .001). Global physical health score reductions were associated with diabetes (bb 1⁄4 −3.81; P 1⁄4 .012), balance or equilibrium problems (bb 1⁄4 −3.82; P 1⁄4 .003), cognitive dysfunction (bb 1⁄4 −4.43; P < .0001), obesity (bb 1⁄4 −3.09; P < .0001), peripheral neuropathy score (bb 1⁄4 −2.12; P < .0001), and depression (bb 1⁄4 −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. © The Author(s) 2023. Published by Oxford University Press. All rights reserved. |
