Adverse health outcomes among US testicular cancer survivors after cisplatin-based chemotherapy vs surgical management

Abstract

We evaluated for the first time, to our knowledge, adverse health outcomes (AHOs) among US testicular cancer survivors (TCS) given chemotherapy (n ¼ 381) vs surgery-only patients (n ¼ 98) managed at a single institution, accounting for non-treatment-related risk factors to delineate chemotherapy’s impact. Chemotherapy consisted largely of bleomycin-etoposide-cisplatin (BEP) administered in three or four cycles (BEPx3, n ¼ 235; BEPx4, n ¼ 82). Incidence of at least 3 AHOs was lowest in surgery-only TCS and increased with BEPx3, BEPx4, and other cisplatin-based regimens (12.2%, 40.8%, 52.5%, 54.8%; P < .0001). Multivariable modeling assessed associations of risk factors and treatment with hearing impairment, tinnitus, peripheral neuropathy, and Raynaud phenomenon. Risk for each AHO statistically increased with both increasing chemotherapy burden (P < .0001) and selected modifiable risk factors (P < .05): hypertension (odds ratio [OR] ¼ 2.40) and noise exposure (OR > 2.3) for hearing impairment; noise exposure for tinnitus (OR > 1.69); peripheral vascular disease for neuropathy (OR ¼ 8.72); and current smoking for Raynaud phenomenon (OR ¼ 2.41). Clinicians should manage modifiable risk factors for AHOs among TCS.