Modifiable adverse health outcomes (AHOs) affect overall mortality and cancer mortality in testicular cancer survivors (TCSs), but had no effect on second cancer (SecCa) incidence. These findings were published in the Journal of Clinical Oncology.

Platinum-based chemotherapy (PBCT) was a gamechanger when it came to improving survival rates for patients with testicular cancer. However, research suggests increased mortality and incidence of SecCa may be associated with nonmodifiable patient-reported AHOs such as age and PBCT treatment.

Using data from the Norwegian Testicular Cancer Project, researchers explored the association between physical and psychosocial AHOs and overall mortality, cancer mortality, and SecCa incidence. Nearly 1000 patients with testicular cancer treated at 1 of the 4 Norwegian university hospitals from 1999 through 2001 were invited to participate in a longitudinal survey. The survey consisted of 3 waves of a mailed questionnaire and a clinical examination. This study is based on the responses to the questionnaire in the first wave.

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The questionnaire was completed by 775 men. Of the respondents, 272 had undergone surgery and 503 received PBCT. Those who received PBCT were further separated into a standard group (total cisplatin, ≤630 mg; 124 TCSs) and a high group (total cisplatin, >630 mg; 379 TCSs).

Prevalence of modifiable AHOs was highest in the PBCT high group compared with the PBCT standard and surgery groups (low socioeconomic status [SES], 23% vs 17% vs 15%; unhealthy lifestyle, 30% vs 30% vs 24%; neurotoxicity, 49% vs 33% vs 31%, respectively).

For this study, modifiable AHOs were low SES, probably depressive disorder, neurotoxicity, and unhealthy lifestyle. Nonmodifiable AHOs included age, treatment, and major comorbidity (diabetes, previous myocardial infarction, or stroke) reported in the first survey.

Risk of overall mortality was almost double for men who reported 1 or 2 AHOs, compared with TCSs who reported no AHOs. Risk of overall mortality and cancer mortality was increased 8-fold and 5-fold, respectively, in TCSs who reported 3 AHOs.

“Health professionals and the TCSs themselves, particularly those after PBCT high, should repeatedly be made aware of these risk factors attempting reduction of these modifiable AHOs and thereby supporting long-term survival,” the researchers advised.

Study limitations included a potential lack of generalizability of these findings because TCSs who underwent primary radiotherapy were excluded, as this treatment is no longer standard therapy for testicular cancer in many countries. Reduced cumulative cisplatin doses may have resulted in fewer AHOs among more recently treated TCSs. These analyses relied on patient-reported AHOs.


Fossa SD, Dahl AA, Thorsen L, et al. Mortality and second cancer incidence after treatment for testicular cancer: psychosocial health and lifestyle are modifiable prognostic factors. J Clin Oncol. Published online April 5, 2022. doi:10.1200/JCO.21.02105