Long-term neurotoxicity and quality of life in testicular cancer survivors-a nationwide cohort study.

To evaluate neurotoxicity in testicular cancer survivors (TCSs) years after treatment and secondly the influence of neurotoxicity on quality-of-life (QoL).

We identified 2234 TCSs who completed the Functional Assessment of Cancer Therapy/Gynecologic Oncology Group-Neurotoxicity questionnaire. QoL was evaluated with the European Organization for Research and Treatment of Cancer QLQ-C30. Patients were grouped according to treatment strategy: surveillance (N = 1113), infradiaphragmatic radiotherapy (N = 301), cisplatin-etoposide-bleomycin (BEP) (N = 759), and more than one line of treatment (MTOL) (N = 61). Association of treatment modality with long-term neurotoxicity was analyzed with ordinal logistic regression. Secondly, associations between neurotoxicity and QoL were analyzed in BEP-treated patients. Analyses were age-adjusted and repeated with additional adjustment for comorbidity, smoking, and alcohol consumption.

After a median follow-up of 18.4 years, treatment with BEP and MTOL was associated with overall increased risk of neurotoxicity (odds ratio 2.4-4.7 depending on treatment intensity, P < 0.001) as well as subscales (peripheral neuropathy, ototoxicity, and dysfunction associated with neuropathy, all P < 0.001). Radiotherapy and surveillance were not associated with neurotoxicity. In patients treated with BEP, neurotoxicity was highly associated with all indicators of worse QoL outcomes (P-trend: 1.5 × 10-17 to 1.1 × 10-28) after almost 20 years of follow-up.

Treatment with BEP was associated with long-term neurotoxicity, which was highly associated with decreased QoL. Strategies to ameliorate or prevent neurotoxicity should be investigated.

Treatment with chemotherapy for testicular cancer induces long-term neuro- and ototoxicity which may have severe influence on quality-of-life years after treatment cessation.

Journal of cancer survivorship : research and practice. 2020 Sep 25 [Epub ahead of print]

Jakob Lauritsen, Mikkel Bandak, Michael Kreiberg, Julie Wang Skøtt, Thomas Wagner, Josephine Julie Rosenvilde, Lars Dysager, Mads Agerbæk, Gedske Daugaard

Department of Oncology, Copenhagen University Hospital, Rigshospitalet, 2100, Copenhagen, OE, Denmark. ., Department of Oncology, Copenhagen University Hospital, Rigshospitalet, 2100, Copenhagen, OE, Denmark., Department of Oncology, Odense University Hospital, Odense, Denmark., Department of Oncology, Aarhus University Hospital, Aarhus, Denmark.

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