The effects of testicular cancer treatment on health-related quality of life

OBJECTIVES: To prospectively describe the effects of adjuvant chemotherapy on health-related quality of life (HRQOL) among men with newly diagnosed non-seminoma germ cell tumors of the testis. Several characteristics of testicular cancer--young age at diagnosis, increasing incidence, and high survival rates--highlight the need for improved understanding of the variables influencing the survivorship experience. METHODS: Participants (n = 116) were identified and recruited from the genitourinary services of 2 large medical centers--one in the United States and the other in The Netherlands. Baseline assessments were administered after diagnostic orchiectomy but before adjuvant treatment. Participants completed follow-up assessments after the completion of the chemotherapy regimen (or 3 months postdiagnosis for participants on surveillance regimens) and 12 months postdiagnosis. The 36-Item Short-Form Health Survey was used to measure HRQOL. RESULTS: Findings indicated that men treated with chemotherapy reported significantly more bodily pain, poorer role physical functioning, poorer social functioning, poorer physical health, more fatigue compared with the men who did not receive chemotherapy at the post-treatment assessment. At the time of 12 month follow-up, HRQOL scores did not vary by treatment group, and scores were significantly higher than baseline HRQOL scores. No significant time by treatment group interactions were observed at the 12 month follow-up. CONCLUSIONS: Results from this study indicate that chemotherapy is associated with only a temporary decrease in HRQOL. Other HRQOL domains, including mental functioning, role emotional, and general health perceptions, were not associated with treatment type at any of the assessment times

Sexual function, depressive symptoms and marital status in nonseminoma testicular cancer patients: a longitudinal study

Goal: To longitudinally investigate sexual functioning in testicular cancer patients during the first year, and examine the effect of relationship status (with a partner or single) and depressive symptoms on sexual functioning.Patients and methods: 93 testicular cancer patients (39% single) treated in two large referral centers for testicular cancer filled in the International Index of Erectile Function (IIEF) and CES-D after orchiectomy (T1) and 3 (T2) and 12 (T3) months later.Results: Orgasmic functioning, overall satisfaction and total sexual functioning decreased between T1 and T2 and increased to an above T1 level at T3. Levels of erectile functioning and intercourse satisfaction were higher at T3 than at T1 and T2. Desire remained stable. Type of treatment did not affect sexual functioning. Singles reported worse sexual functioning at all measurement times than committed patients, and comparable desire. One year after surgery, singles also reported worse sexual functioning on three domains when compared with norms. Depressive symptoms were highest and significantly but weakly related to one domain of sexual functioning at T1, to three domains at T2, and to none at T3. Early depressive symptoms had small to moderate predictive power on sexual functioning at T2, but not at T3.Conclusion: Sexual functioning, but not desire, fluctuates during the first year after testicular cancer. Type of treatment and depressive symptoms were no risk factors for sexual dysfunction in the longer term. Singles reported more sexual problems than patients in a relationship and norms, they may need more information and guidance concerning their sexuality. Copyright (c) 2009 John Wiley & Sons, Ltd

Cognitive impairment in men with testicular cancer prior to adjuvant therapy

BACKGROUND:: Cognitive dysfunction experienced by individuals with cancer represents an important survivorship issue because of its potential to affect occupational, scholastic, and social activities. Whereas early efforts to characterize cognitive dysfunction primarily focused on the effects of chemotherapy, more recent evidence indicates that impairment may exist before systemic treatment. This study characterized cognitive dysfunction before adjuvant chemotherapy in a sample of men diagnosed with nonseminomatous germ cell tumors (NSGCT) of the testis. METHODS:: Men with newly diagnosed NSGCT were recruited after orchiectomy but before adjuvant chemotherapy. Patients completed neuropsychological tests to assess attention, learning, language, executive function, and motor function. Self-report measures of depression and anxiety were also administered. An overall cognitive function index was computed for participants. Cognitive impairment was defined as a z-score of less than or equal to -1.5 on 2 or more tests, or a z-score of less than or equal to -2.0 on a single test. RESULTS:: Approximately 46% of patients exhibited cognitive impairment at the time of assessment, which is significantly greater than would be expected considering healthy population norms (binomial test: P < .0001). Patients exhibited impairments in motor function, verbal learning, and executive function much more frequently relative to normative expectations (binomial test: P < .0001). CONCLUSIONS:: The prevalence of cognitive impairment in men with newly diagnosed NSGCT is unexpectedly high before the receipt of adjuvant chemotherapy. Efforts to track cognitive function over time and to develop effective interventions are warranted. Cancer 2010. (c) 2010 American Cancer Society