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Side Effects and Cancer-Related Stress Determine Quality of Life in Long-Term Survivors of Testicular Cancer

From the Research Centre for Health Promotion and Department of Oncology, Haukeland University Hospital, University of Bergen, Bergen; Department of Clinical Cancer Research, The Norwegian Radium Hospital; Departments of Psychiatry and Oncology, Ullevaal University Hospital, and Medical Faculty, University of Oslo, Oslo; Department of Oncology, University Hospital of Northern Norway, University of Tromsø, Tromsø; and Department of Oncology, Saint Olav's Hospital, National University for Science and Technology, Trondheim, Norway

Address reprint requests to Sophie D. Fosså, MD, PhD, The Norwegian Radium Hospital, Montebello, N-0310 Oslo, Norway; e-mail: s.d.fossa{at}klinmed.uio.no

PURPOSE: The prevalence of long-term survivors after treatment for testicular cancer (TC) is increasing, and most studies display normal or only slightly reduced quality of life (QOL) in TC survivors (TCSs). Impaired QOL is claimed to be associated with treatment modality and its side effects, although most studies in this field can be criticized for various methodologic shortcomings. We wanted to examine variation in long-term QOL in TCSs in relation to TC treatment modality, side effects, and TC-related stress in a large population.

PATIENTS AND METHODS: QOL, side effects, and TC-related stress were self-rated by a questionnaire at a mean of 11 years of follow-up in 1,409 TCSs treated from 1980 to 1994. Norm data was obtained from 2,678 males who were representative of the general population. QOL was measured with the Short Form-36 (SF-36), and TC-related stress was measured with the Impact of Event Scale.

RESULTS: There were no clinically relevant differences in QOL between TCSs and age-adjusted norm data, although there was a slightly lowered SF-36 Physical Component Summary Score in TCSs. Variation of QOL in TCSs was related to self-reported side effects and TC-related stress but not to TC treatment modality. A significant association was found between side effects and TC-related stress.

CONCLUSION: TCSs do not suffer long term from reduced QOL, and only minor differences in QOL were found between different treatment modalities. TCSs who report more side effects or TC-related stress have increased risk for reduced QOL, but these associations are not explained by TC treatment modalities. Further QOL research in this area should explore vulnerability factors for side effects and TC-related stress.

Supported by Cancer Registry of Norway, The Norwegian Cancer Society, The Norwegian Foundation for Health and Rehabilitation, and Bothner's Foundation in Norway.

Authors' disclosures of potential conflicts of interest are found at the end of this article.

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