An Updated Systematic Review of Quantitative Studies Assessing Anxiety, Depression, Fear of Cancer Recurrence or Psychological Distress in Testicular Cancer Survivors

Abstract

Purpose: A diagnosis of testicular cancer (TC) at a relatively young age can have a dramatic impact on the psychological well-being of those affected. The aim of this review was to synthesize recent evidence to provide an updated account of the prevalence, severity and correlates of anxiety, depression, fear of cancer recurrence (FCR) and distress in TC survivors. Patients and Methods: A systematic literature review was conducted from September 2017 until June 2020 using electronic databases including Embase, MEDLINE, PsycINFO, Scopus and Web of Science. Study eligibility and quality were independently assessed by two reviewers. Narrative synthesis was used to depict the severity (mean/median scores), prevalence (proportions above standard clinical thresholds) and correlates of study outcomes. Results: A total of 988 articles were identified for screening after duplicate removal. Fiftysix full-text articles were screened, and eight articles met the inclusion criteria. The reported prevalence of the outcomes varied across studies (clinical levels of anxiety ranged from 6.9% to 21.1%, depression varied from 4.7% to 7%, distress was found between 25% and 41.4%, prevalence of FCR was not reported). Few studies compared TC survivors with other populations. Correlates of poorer psychological outcomes included younger age, relationship status, employment status, poorer sexual functioning, impaired masculinity and coping strategies. Conclusion: Anxiety seems to be the most common issue for TC survivors. Men who are single or unemployed appear most at risk of poorer psychological outcomes, which seem associated with impaired masculinity and sexual function. More research is needed to identify TC survivors most likely to need one of the increasing number of psychological interventions being developed for TC survivors.

The impact of testicular cancer and its treatment on masculinity: A systematic review

“…15 In a recent review, the role of cancer-related masculine threat (i.e., the perception that cancer is inconsistent with masculine gender) following TC was implicated in some men's heightened levels of depression and anxiety. 16 Masculinity may be of specific importance within the TC context. Biological theories of masculinity suggest that anatomy is a 'verification' of gender 17 and thus an altered or damaged reproductive system can have deleterious impacts on one's sense of their 'manhood'.…”

“…This year, TC was shown to have the highest cumulative burden for depression and the highest psychiatric disorder burden overall compared to 25 other cancers 15 . In a recent review, the role of cancer‐related masculine threat (i.e., the perception that cancer is inconsistent with masculine gender) following TC was implicated in some men's heightened levels of depression and anxiety 16 …”

Role for a Web-Based Intervention to Alleviate Distress in People With Newly Diagnosed Testicular Cancer: Mixed Methods Study

“…Other studies evaluating psychological interventions for the management of distress in patients with cancer, have similarly highlighted that earlier interventions lead to reduced stress, improved quality of life, and superior clinical outcomes [ 18 ]. With conflicting reports regarding the prevalence of long-term distress in survivors of testicular cancer [ 9 , 10 , 43 ], early intervention is important for those who wish to receive it. In addition, as a clinical trial requiring consent, the study may have introduced a potential selection bias for “active copers” rather than individuals with passive coping strategies [ 6 ], which may be reflected in the 70% (39/56) response rate for study involvement.…”

“…There have been significant advances in the treatment of testicular cancer in recent decades, such that >97% of individuals can expect a cure [1][2][3]. While being cancer free, survivors may experience physical, psychological, and social consequences that persist long after their diagnosis and treatment, including cardiovascular morbidity, hypogonadism, second malignancy, and residual chemotherapy toxicities [4][5][6][7][8][9]. Psychological distress is common immediately following diagnosis [10][11][12][13], with a large retrospective study of survivors of testicular cancer suggesting that distress was most significant at this time compared with other periods of their cancer journey [13].…”

“…Psychological distress is common immediately following diagnosis [10][11][12][13], with a large retrospective study of survivors of testicular cancer suggesting that distress was most significant at this time compared with other periods of their cancer journey [13]. Distress is multifactorial; however, it frequently stems from a perceived lack of information regarding treatment and prognosis [14] and is influenced by risk factors including education level, chronic illness, absence of paid employment, relationship status, and treatment-related factors, such as concomitant use of chemotherapy [6,9,[15][16][17][18]. Importantly, some individuals may experience persistent symptoms leading to chronic anxiety and depression [19], such that the prevalence and severity of anxiety reported in long-term survivors of testicular cancer is higher than in the general population, with up to 21% of survivors reporting persistent symptoms [9].…”