Impact of Pain and Adverse Health Outcomes on Long-term U.S. Testicular Cancer Survivors.

PURPOSE: No study has quantified the impact of pain and other adverse health outcomes (AHOs) on global physical/mental health in long-term U.S. testicular cancer survivors (TCS) or evaluated patient-reported functional impairment due to pain.

METHODS: TCS given cisplatin-based chemotherapy completed validated surveys, including PROMIS-v1.2 Global-Physical-and-Mental-Health, PROMIS pain questionnaires, and others. Multivariable linear regression examined relationships between 25 AHOs with Global-Physical (GPH) and Mental-Health (GMH) scores, and Pain-Interference Scores. AHOs with β > 2 are clinically important and reported below.

RESULTS: Among 358 TCS [median age: 46 (IQR: 38-53); median time-since-chemotherapy: 10.7 years; IQR = 7.2-16.0)], median AHO number was 5 (IQR = 3-7). 12% TCS had ≥10 AHOs, and 19% reported chemotherapy-induced neuropathic pain. Increasing AHO numbers were associated with decreases in physical and mental health (P < 0.0001 each). In multivariable analyses, chemotherapy-induced neuropathic pain (β = -3.72; P = 0.001), diabetes (β = -4.41; P = 0.037), obesity (β = -2.01; P = 0.036) and fatigue (β = -8.58; P < 0.0001) were associated with worse GMH, while being married/living-as-married benefitted GMH (β = 3.63; P = 0.0006). Risk factors for pain-related functional-impairment included lower extremity location (β = 2.15; P = 0.04) and concomitant peripheral artery disease (β = 4.68; P < 0.001). GPH-score reductions were associated with diabetes (β = -3.81; P = 0.012), balance/equilibrium problems (β = -3.82; P = 0.003), cognitive-dysfunction (β = -4.43; P < 0.0001), obesity (β = -3.09; P < 0.0001), peripheral-neuropathy-score (β = -2.12; P < 0.0001), and depression (β = -3.17; P < 0.0001).

CONCLUSIONS: TCS suffer AHOs that negatively impact long-term GMH, GPH, and pain-related functional-status.

IMPLICATIONS FOR CANCER SURVIVORS: Clinically important factors associated with worse physical/mental health identify TCS requiring closer monitoring, counseling, and interventions. Chemotherapy-induced neuropathic pain must be addressed, given its detrimental impact on patient-reported functional-status and mental health 10+ years after treatment.