Cardiovascular disease in testicular cancer survivors: Identification of risk factors and impact on quality of life.

Abstract

12070 Background: Testicular cancer (TC) treatment has been associated with cardiovascular disease (CVD) development. To facilitate development of preventive strategies, this study assessed risk factors associated with CVD in TC survivors. Methods: Incidence of coronary artery disease, myocardial infarction and heart failure was assessed in a multicenter cohort comprising 4,748 TC survivors treated at ages of 12-50 years between 1976-2007. Patients who developed CVD and a random sample from the cohort received a questionnaire on cardiovascular risk factors (CVRF) and quality of life (QoL, measured with SF-36). A subgroup (n=304) of responders in the cohort additionally underwent clinical evaluation of CVRF. Results: After a median follow-up of 16 years, 272 patients developed CVD. Compared to orchidectomy only, platinum-based chemotherapy was associated with increased CVD risk (Hazard Ratio (HR) 1.8, 95% Confidence Interval(CI) 1.3-2.5). CVD risk was increased among patients who were obese or a smoker at diagnosis (HR 4.7, 95%CI 2.4-9.3 and HR 1.5, 95%CI 1.1-2.2, respectively) and patients with Raynaud's phenomenon (HR 1.9, 95%CI 1.1-3.6) or a family history of CVD (HR 2.7, 95%CI 1.6-4.5). TC survivors with CVD reported inferior QoL on physical domains (table). In TC survivors who underwent clinical evaluation for CVRF (median age at assessment 51 years), 86% had dyslipidemia, 50% hypertension and 35% metabolic syndrome, irrespective of treatment. Conclusions: TC survivors treated with platinum-based chemotherapy, who were obese or smoking at diagnosis, had family history of CVD and who developed Raynaud’s phenomenon are at risk to develop CVD, which affects QoL. Many TC survivors carry undetected CVRF. We advocate early lifestyle adjustments and lifelong follow-up with low-threshold treatment of CVRF, especially in obese and smoking patients treated with platinum-based chemotherapy. [Table: see text]

Identification of Cardiovascular Disease Risk Factors in Testicular Cancer Survivors and the Impact on Quality of Life

“…Cardiovascular events in TC survivors impair QoL. 1 We support and appreciate the authors' work and agree with their conclusions, but have some concerns about some of the details in the article.First, the authors noted that chemotherapy treatment was associated with an increased risk of CVD compared with orchidectomy only (hazard ratio [HR], 1.9; 95% CI, 1.1 to 3.1), and this risk further increased when patients also received radiotherapy (HR, 2.5; 95% CI, 1.2 to 5.1). 1 If the authors could increase the specific classification and cumulative dose of chemotherapy drugs and perform stratified analysis to study the impact of each chemotherapy drug on CVD risk, it may help further explain the risk differences in specific cardiovascular diseases among patients with TC.…”

“…Cardiovascular events in TC survivors impair QoL. 1 We support and appreciate the authors' work and agree with their conclusions, but have some concerns about some of the details in the article.…”

“…We read with interest the recent publication by Lubberts et al 1 on cardiovascular disease (CVD) in testicular cancer (TC) survivors: identification of risk factors and impact on quality of life (QoL). The authors concluded that patients with platinum-based chemotherapy, obesity and smoking at diagnosis, Raynaud's phenomenon after treatment, or dyslipidemia during follow-up are at increased risk of developing CVD.…”

Children's Oncology Group's 2023 blueprint for research: Germ cell tumors

“…10,11 Ototoxicity, neuropathy, second cancers, and cardiovascular disease are well-established late effects in adult testicular GCT survivors. [12][13][14][15] Because children and adolescents are treated with the same chemotherapy agents, it is likely that similar late effects occur.…”

“…The Platinum Study is seminal in characterizing the late effects of therapy and their impact on quality of life in adults with testicular GCTs 10,11 . Ototoxicity, neuropathy, second cancers, and cardiovascular disease are well‐established late effects in adult testicular GCT survivors 12–15 . Because children and adolescents are treated with the same chemotherapy agents, it is likely that similar late effects occur.…”