In the last couple of decades, we have witnessed an increase in the incidence of cancer worldwide, particularly in Western Europe and the United States. Fortunately, this trend is accompanied by improvements in cure rates. As a result, an increasing proportion of the population is living in the survivorship phase.
A similar pattern has been observed in testicular cancer (TC), which is one of the first solid organ tumours to be cured, even in advanced stages. Since 1976, when cisplatin-based chemotherapy became the standard of care, more than 95% of patients with TC have been cured.
These patients are typically diagnosed and treated at a young age, which means they live many years to experience the late effects of cancer and treatment. Recently, we have seen a surge in studies highlighting the ordeal faced by TC survivors. Several registry-based studies have demonstrated lower life expectancy compared to the general population, with second malignant neoplasms being the leading cause of death, followed by cardiovascular events. The morbidity in this cohort is also surprisingly high in turn causing significant financial, social, and emotional burdens.
As noted, TC is usually diagnosed in younger patients, and late side effects often affect those between the ages of 25 to 50. Unfortunately, support and services for these survivors remain almost non-existent.
The objective of this article is to provide an up-to-date, comprehensive, and accessible account of long-term sequelae associated with TC. A better understanding of these issues will hopefully help us develop pathways and services to improve care for survivors.
Written by: M. Raheel Khan, MD, Consultant Medical Oncologist, St James’s Hospital, Dublin, Ireland
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