Introduction: Despite the excellent long-term prognosis after treatment for testicular cancer (TC), therapy-related side effects can be persistent and severe. Here we study the medium-long term Health-related quality of life (HRQoL) and treatment-related symptoms of TC survivors.
Methods: Data from 81 patients divided into 3 treatment groups were analysed (1: Orchidectomy alone – reference group; 2: Multi-agent induction chemotherapy (CBOP-BEP, BEPx3 or x4, EPx4 regimens); 3: PC-RPLND). HRQoL was assessed using the validated EQ-5D-5L together with EORTC TC26, a TC-specific questionnaire that has been previously used to study post-treatment side effect severity. To evaluate the medium to long term side effects of treatment, all patients included in the study had completed TC treatment 12 to 24 months before the administration of the questionnaire.
Results: Based on EQ-5D-5L, patients treated with multi-agent chemotherapy and patients treated with PC-RPLND exhibited greater impairment in the mobility, self-care, usual activities, and pain/discomfort domains, compared to the orchidectomy group (5.3% and 18.2% Vs 0%; 0% and 10% Vs 0%; 36.9% and 32% Vs 5.3%; 42% and 37% Vs 21%; respectively). Conversely, in the anxiety domain, patients treated with orchidectomy alone reported the highest scores (58% Vs 44% and 51%). Based on the EORTC TC26, both multi-agent chemotherapy and PC-RPLND demonstrated higher impact on physical domains compared to orchidectomy alone. Specifically multi-agent chemotherapy had the highest impact on loss of muscle strength (68.5% Vs 41%), peripheral nervous system side effects (68.5% Vs 15%) and Raynaud’s phenomenon (52.6% Vs 21.1%), while PC-RPLND mostly affected pain-related domains (37% Vs 10%) and ejaculatory dysfunction (64% Vs 15.8%). In addition, both multi-agent chemotherapy and PC-RPLND were associated with a greater adverse treatment-related impact on job/education compared to orchidectomy alone (47% and 42% Vs 29%).
Conclusions: This study reports the medium to long-term HRQoL impact of TC treatments, using both EQ-5D-5L and EORTC TC26 questionnaires. Our findings will help inform patients during counselling regarding side effects and QoL impact of different treatment modalities. Future studies evaluating de-escalation strategies in selected patient groups with systemic disease are required to assess the impact of different treatments and most importantly engage patient groups to define other metrics which they consider of importance in their long-term future.