SUO 2017: Testicular Cancer And Surveillance: Impact On Patient Anxiety Over Time, The Princess Margaret Cancer Centre Experience

Washington, DC ( Introduction: Surveillance has become a standard of care for stage 1 testicular cancer. However, little is known about its effects on anxiety and mental health. With some centers advocating adjuvant therapy for higher risk stage I disease, partially on the basis of patient anxiety, a better understanding of patients’ response to surveillance is required.

Methods: The Princess Margaret Cancer Centre (PMCC) institutional cohort of testicular cancer patients was queried for all patients who were initiated on surveillance. From 2014-2017, all patients were asked to complete a comprehensive questionnaire, including the Edmonton Symptom Assessment System (ESAS), which is scored from 0 [no anxiety] to 10 [worst
possible anxiety]. Patients with a score ≥ 3 are prompted to complete a Generalized Anxiety Disorder 7 survey (GAD7), scored from 0 – 21, and correlates to mild (5), moderate (10), and severe anxiety (15+).

Results: Of 805 patients who completed at least one survey, 349 patients were initiated and maintained on surveillance at PMCC. Of these, 101 had non-seminomatous germ cell tumors (NSGCT) and 245 had seminoma. Patients completed between 1-18 surveys during follow-up (median 2, mean 3.4). On the first survey, there was a 100% response rate for ESAS, and 25.1% were prompted and completed GAD7 surveys; response rates diminished over time. ESAS-anxiety and GAD7 scores for all responders were stratified by time from initial PMCC consultation. Patients had consistently mild anxiety during the follow-up period, regardless of metric. ESAS-anxiety demonstrated median scores 0-1 for 10+ years of follow-up. Subset analysis of 82 patients who had a minimum of 2 responses within 6 months of orchiectomy demonstrated similar findings.

Conclusion: Patients on surveillance for testicular cancer have stable very mild anxiety during long-term follow-up. The authors conclude that Intervention based on concern for patient anxiety for higher-risk stage 1 testicular cancer is probably not justified.

Presented by: Thenappan Chandrasekar, Toronto, Canada

Written by: Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre, @GoldbergHanan, at the 18th Annual Meeting of the Society of Urologic Oncology, November 29-December 1, 2017 – Washington, DC
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