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Cumulative Burden of Morbidity Among Testicular Cancer Survivors After Standard Cisplatin-Based Chemotherapy: A Multi-Institutional Study
- Source :
- Journal of clinical oncology : official journal of the American Society of Clinical Oncology. 36(15)
- Publication Year :
- 2018
-
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 (χ2 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.
- Subjects :
- Oncology
Adult
Male
Cancer Research
medicine.medical_specialty
medicine.medical_treatment
Urology
Health Status
Long Term Adverse Effects
Physical examination
Severity of Illness Index
03 medical and health sciences
0302 clinical medicine
Cancer Survivors
Testicular Neoplasms
Risk Factors
Internal medicine
Surveys and Questionnaires
Severity of illness
Antineoplastic Combined Chemotherapy Protocols
medicine
Humans
Survivors
030212 general & internal medicine
Exercise
Physical Examination
Testicular cancer
Chemotherapy
medicine.diagnostic_test
business.industry
Medical record
ORIGINAL REPORTS
Middle Aged
Neoplasms, Germ Cell and Embryonal
medicine.disease
Multicenter study
Cisplatin based chemotherapy
030220 oncology & carcinogenesis
Ordered logit
Morbidity
Cisplatin
business
Factor Analysis, Statistical
Subjects
Details
- ISSN :
- 15277755
- Volume :
- 36
- Issue :
- 15
- Database :
- OpenAIRE
- Journal :
- Journal of clinical oncology : official journal of the American Society of Clinical Oncology
- Accession number :
- edsair.doi.dedup.....824d1925ccaf656315db3b151bd0604e