A Systematic Review of Quantitative Observational Studies Investigating Psychological Distress in Testicular Cancer Survivors

Testicular cancer (TC) affects young men and may cause psychological distress despite a good prognosis. This systematic review evaluated the prevalence, severity and correlates of anxiety, depression, fear of cancer recurrence (FCR) and distress in TC survivors.

A systematic search of literature published 1977-2017 was conducted to find quantitative studies including TC survivor-reported outcomes relevant to review objectives. The quality of included articles was assessed, and a narrative synthesis conducted.

Of 6717 articles identified, 66 (39 good, 20 fair, 7 poor quality) reporting results from 36 studies were included. TC survivors' mean anxiety levels were higher than in the general population, while mean depression and distress were no different. Clinically significant anxiety (≈1 in 5) and to a lesser extent distress (≈1 in 7), but not depression, were more prevalent in TC survivors than the general population. Approximately 1 in 3 TC survivors experienced elevated FCR. Poorer psychological outcomes were more common among TC survivors who were: single, unemployed/low socioeconomic status (SES), suffering from comorbidities, experiencing worse symptoms/side effects, and using passive coping strategies.

Many TC survivors do not experience significant psychological morbidity, but anxiety and FCR are prevalent. Inadequate coping resources (e.g. low SES and social support) and strategies (e.g. avoidance) and greater symptoms/side effects were associated with poorer outcomes. Theoretically-driven prospective studies would aid understanding of how outcomes change over time and how to screen for risk. Age and gender appropriate interventions that prevent and manage issues specific to TC survivors are also needed.

Psycho-oncology. 2017 Nov 23 [Epub ahead of print]

Allan 'Ben' Smith, Claudia Rutherford, Phyllis Butow, Ian Olver, Tim Luckett, Peter Grimison, Guy Toner, Martin Stockler, Madeleine King

Centre for Oncology Education and Research Translation (CONCERT), Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, University of New South Wales., Psycho-Oncology Co-operative Research Group (PoCoG), University of Sydney, Sydney, NSW, Australia., Australian and New Zealand Urogenital and Prostate Cancer Trials Group Limited (ANZUP), Sydney, NSW, Australia., Improving Palliative, Chronic and Aged Care through Clinical Trials Research and Translation (ImPaCCT), South Western Sydney Clinical School, Faculty of Health, University of New South Wales and University of Technology Sydney, Sydney, NSW, Australia.