Abstract
Early testicular cancer is highly curable, with five-year survivals over 95% and life expectancies of forty years after diagnosis [Abouassaly, 2011]. Mortality and morbidity can occur due to late effects of the cancer and treatment, including secondary malignancies, cardiotoxicity, nephrotoxicity, fatigue, anxiety and sexual dysfunction [Fossa, 2007; Hanna, 2014]. Late effects may be overlooked in a ‘cancer surveillance’ clinic, missing opportunities for supportive care interventions.
Methods
Following local ethics committee approval, we collected data from patients with testicular seminoma who were treated at Eastern Health between 1995 and 2010. Late effects documented 2-10 years after diagnosis were recorded.
Results
A total of fifty-nine eligible patients with testicular seminoma were included, with a median follow-up of 4 years. The mean age at diagnosis was 39.6 years. Fifty-six patients had stage 1 disease, fifty-five had adjuvant chemotherapy (fifty-two received single-dose carboplatin). Eight patents relapsed, with seven requiring further chemotherapy.
The most common late effect was sexual dysfunction: three patients reported decreased sexual desire or satisfaction; two reported erectile dysfunction; and two patients had biochemical evidence of hypogonadism. Eight patients had abnormal semen analysis and conception of children was documented in two patients. Symptomatic fatigue and anxiety were each recorded in two patients. Other documented late effects included neuropathy (four patients), cardiovascular disease (two) and respiratory disease (two). Twenty-eight (47%) patients had no documentation regarding late effects.
Discussion
There is limited documentation of late effects in standard oncology follow-up clinics. It is therefore difficult to establish the true incidence of late effects within this patient group, or to appreciate the clinical significance. A system designed to routinely screen for potential late effects will enable earlier recognition and improve supportive care of these patients.