Testicular Cancer Treatment May Increase Risk for Heart Disease in Survivors
Recent research has found that survivors of testicular cancer have a greater risk of developing metabolic syndrome.
Oncology nurses can have a significant impact on the lives of patients with testicular cancer, the most common malignancy afflicting men ages 18 to 39 years. Although incidence of testicular cancer has increased over the last 2 decades, the news about this cancer can be heartening: treatment results in a cure for most patients. However, any good news should always be tempered with caution. Testicular cancer is no exception.1
Recent research has found that survivors of testicular cancer have a greater risk of developing metabolic syndrome. The syndrome is characterized by the presence of 3 or more of the following conditions: hypertension, hypertriglyceridemia, abdominal obesity, low high-density lipoprotein (HDL) level, and type 2 diabetes. Any one of these conditions increases the risk of developing heart disease.
Cisplatin-based chemotherapy is the treatment of choice for patients with testicular cancer. Its use has led to a cure rate of 80% for patients with metastatic disease and an overall 5-year survival rate of 95%. The result is that now 1 of every 600 men in the United States is a testicular cancer survivor. Young men who survive the disease can expect to live for approximately 40 more years, comprising a large population ideal for studying the long-term effects of chemotherapy for this cancer, particularly the metabolic effects.
Signs of Metabolic Syndrome
The National Cancer Institute has funded the Platinum Study for this purpose. It is the largest study to evaluate the numbers of metabolic abnormalities among testicular cancer survivors from North America who were treated with platinum-based chemotherapy. A study population solely from North America provides an advantage over a European-based population for analyzing metabolic syndrome because people in North America tend to be more ethnically and genetically diverse, noted Mohammad Abu Zaid, MD, assistant professor of medicine, Indiana University School of Medicine and Indiana University Melvin and Bren Simon Cancer Center.
“Testicular cancer survivors are all at risk for hypogonadism (low testosterone) which places them at risk for metabolic syndrome and future heart disease,” Dr Zaid explained to Oncology Nurse Advisor. “In addition, other known risk factors for cardiovascular disease such as obesity — also common among survivors and the US population in general — can add to the risk.”
For this study, researchers evaluated 486 testicular cancer survivors, median age 38 years, and selected matched controls from the National Health and Nutrition Examination Survey (NHANES). The control population was men who had no cancer, matched for race, age within 5 years, and level of education.
Study results revealed that 43% of the survivors were hypertensive, compared with 31% of controls. The survivors were less likely to have decreased HDL (the “good” cholesterol) levels: 24% vs 35% for the controls. They also had less abdominal obesity (28%) than did the controls (40%).
The investigators found that 3 of every 4 testicular cancer survivors were overweight or obese, 43% had hypertension, and a significantly higher proportion of survivors had elevated LDL or total cholesteral levels compared with matched controls. Overall, 1 in 5 testicular cancer survivors had metabolic syndrome, based on the National Cholesterol Education Program (NCEP) Adult Treatment Panel III (ATP III) definition.