Testicular cancer (TC) treatment is clearly associated with cardiovascular morbidity and mortality. To enable development of preventive strategies for cardiovascular disease (CVD), we assessed cardiometabolic risk factors and quality of life (QoL) in TC survivors.
Incidence of coronary artery disease, myocardial infarction, and heart failure after TC treatment was assessed in a multicenter cohort comprising 4,748 patients treated at the age of 12-50 years between 1976 and 2007. Patients who had developed CVD and a random sample from the cohort (subcohort) received a questionnaire on cardiometabolic risk factors and QoL. A subgroup of responders in the subcohort additionally underwent clinical evaluation of cardiovascular risk factors.
After a median follow-up of 16 years, 272 patients had developed CVD. Compared with orchidectomy only, cisplatin combination chemotherapy was associated with an increased CVD risk (hazard ratio [HR], 1.9; 95% CI, 1.1 to 3.1). Patients who were obese or a smoker at diagnosis (HR, 4.6; 95% CI, 2.0 to 10.0 and HR, 1.7; 95% CI, 1.1 to 2.4, respectively), developed Raynaud's phenomenon (HR, 1.9; 95% CI, 1.1 to 3.6) or dyslipidemia (HR, 2.8; 95% CI, 1.6 to 4.7) or had a positive family history for CVD (HR, 2.9; 95% CI, 1.7 to 4.9) had higher CVD risk. More TC survivors with CVD reported inferior QoL on physical domains than survivors who did not develop CVD. Of 304 TC survivors who underwent clinical evaluation for cardiovascular risk factors (median age at assessment: 51 years), 86% had dyslipidemia, 50% had hypertension, and 35% had metabolic syndrome, irrespective of treatment.
Cardiovascular events in TC survivors impair QoL. Many TC survivors have undetected cardiovascular risk factors. We advocate early lifestyle adjustments and lifelong follow-up with low-threshold treatment of cardiovascular risk factors, especially in obese and smoking patients treated with platinum-based chemotherapy.
Journal of clinical oncology : official journal of the American Society of Clinical Oncology. 2023 Apr 18 [Epub ahead of print]
Sjoukje Lubberts, Harmke J Groot, Ronald de Wit, Sasja Mulder, Johannes A Witjes, J Martijn Kerst, Gerard Groenewegen, Joop D Lefrandt, Flora E van Leeuwen, Janine Nuver, Michael Schaapveld, Jourik A Gietema
Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands., Department of Epidemiology, Netherlands Cancer Institute, Amsterdam, the Netherlands., Department of Medical Oncology, Erasmus Medical Center, Rotterdam, the Netherlands., Department of Medical Oncology, Radboud University Medical Center, Nijmegen, the Netherlands., Department of Urology, Radboud University Medical Center, Nijmegen, the Netherlands., Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands., Department of Medical Oncology, University Medical Center Utrecht, Utrecht, the Netherlands., Department of Vascular Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.