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© 2003 American Society for Clinical Oncology
Long-Term Survivors of Testicular CancerDepartment of Hepatogastroenterologie, CHRU, Hôptial Claude Huriez, Lille, France To the Editor: Huddart et al1 have recently presented an interesting study in this journal on cardiovascular events in long-term survivors of testicular cancer. In that study, the authors documented an increased risk in patients treated previously with radiotherapy, chemotherapy, or both, when compared with surveillance-only patients. The study included a large cohort of patients, and the physiologic mechanisms proposed for cardiovascular disease that may follow cancer therapy are entirely plausible. Importantly, this study documents one of the highest rates of long-term cardiovascular events in testicular cancer survivors so far. However, it is possible that some of the included criteria for defining cardiovascular disease may have inflated the overall magnitude of risk. The authors document that out of the 68 patients having a cardiac event, 41 patients (60%) were defined by the symptoms of angina or chest pain alone, as determined by patient questionnaires or retrospective general practitioner or physician records. Verification of a cardiovascular etiology for these symptoms is not presented for this subgroup. It is known that even angina-like chest pain is sometimes noncardiac in origin, and that differentiating chest pain of cardiac versus noncardiac origin may be difficult or impossible on the basis of history alone.2 Up to 30% of unselected patients presenting with angina-like chest pain have normal coronary arteries documented at subsequent angiography.3 In general, the prognosis of such patients (who are often young) is good. Of additional significance are the dual observations that many patients with noncardiac chest pain have associated psychologic dysfunction, including anxiety,4,5 and that an elevated level of chronic anxiety exists among a significant proportion of long-term survivors of testicular cancer.6 Thus, in the study by Huddart et al, it is unclear what proportion of patients with cardiovascular events defined by chest pain actually had noncardiac chest pain, with or without associated psychologic dysfunction. Nonetheless, this work attests to the ongoing need for long-term follow-up of such patients, and for continued attention to minimizing the toxicity of therapy. AUTHOR’S DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST The author indicated no potential conflicts of interest. REFERENCES
1. Huddart RA, Norman A, Shahidi M, et al: Cardiovascular disease as a long-term complication of treatment for testicular cancer. J Clin Oncol 21:1513–1523, 2003 2. Botoman VA: Noncardiac chest pain. J Clin Gastroenterol 34:6–14, 2002[CrossRef][Medline] 3. Nevens F, Janssens J, Piessens J, et al: Prospective study on prevalence of esophageal chest pain in patients referred on an elective basis to a cardiac unit for suspected myocardial ischemia. Dig Dis Sci 36:229–235, 1991[CrossRef][Medline] 4. Kane FJ, Stronhlein J, Harper RG: Noncardiac chest pain in patients with heart disease. South Med J 84:847–852, 1991[Medline] 5. Richter JE, Obrecht WF, Bradley LA, et al: Psychologic comparison of patients with nutcracker esophagus and irritable bowel syndrome. Dig Dis Sci 31:131–138, 1986[CrossRef][Medline]
6. Fosså SD, Dahl AA, Loge JH: Fatigue, anxiety, and depression in long-term survivors of testicular cancer. J Clin Oncol 21:1249–1254, 2003
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Copyright © 2003 by the American Society of Clinical Oncology, Online ISSN: 1527-7755. Print ISSN: 0732-183X
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