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

Dinh PC, Monahan PO, Fosså SD, Sesso HD, Feldman DR, Dolan ME, Nevel K, Kincaid J, Vaughn DJ, Martin NE, Sanchez VA, Einhorn LH, Frisina R, Fung C, Kroenke K, Travis LB. Impact of Pain and Adverse Health Outcomes on Long-term U.S. Testicular Cancer Survivors. Journal of the National Cancer Institute. 2023 Nov 15.

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Abstract:

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 > 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 ( = -3.72; P = 0.001), diabetes ( = -4.41; P = 0.037), obesity ( = -2.01; P = 0.036) and fatigue ( = -8.58; P < 0.0001) were associated with worse GMH, while being married/living-as-married benefitted GMH ( = 3.63; P = 0.0006). Risk factors for pain-related functional-impairment included lower extremity location ( = 2.15; P = 0.04) and concomitant peripheral artery disease ( = 4.68; P < 0.001). GPH-score reductions were associated with diabetes ( = -3.81; P = 0.012), balance/equilibrium problems ( = -3.82; P = 0.003), cognitive-dysfunction ( = -4.43; P < 0.0001), obesity ( = -3.09; P < 0.0001), peripheral-neuropathy-score ( = -2.12; P < 0.0001), and depression ( = -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.