Because testicular cancer has a 95 percent cure rate, it is easier for men to move on and forget about it. But new research in the Journal of Clinical Oncology shows that it’s prudent for patients to stay in touch with their medical team as they age and to be aware of treatment toxicities.
The main worry is not a return of cancer, but side effects from platinum-based chemotherapy (cisplatin, for example), which is associated with health problems that can creep up years later, including heart disease, hearing loss, pain, neuropathy, and erectile dysfunction.
“Some men are in their mid-20s when they undergo treatment and they may have 50 or more years of life, and you want that to be a high-quality life,” says Chunkit Fung, M.D., a study co-author and oncologist at the Wilmot Cancer Institute who treats people with genitourinary cancers (testicular, prostate, bladder, and kidney). “Screening and treating some of these long-term toxicities such as hypertension and heart disease, early on, is important.”
The research shows that late-onset side effects can occur in clusters, such as erectile dysfunction paired with thyroid disease, or as different types of cardiovascular problems like coronary artery disease, vessel damage, and obesity, added Sarah Kerns, Ph.D., the study’s first author, and an assistant professor in the Department of Radiation Oncology at the University of Rochester Medical Center and a Wilmot investigator.
The study involved more than 1,200 testicular cancer survivors who were treated with chemotherapy. Scientists evaluated the cumulative burden of diseases following treatment and found the most common negative health outcomes were obesity, sensory neuropathy, ringing in the ears and hearing damage. Only about five percent of patients had no negative health effects, and 76 percent had a low-to-medium burden of side effects. Nineteen percent had a high-to-severe disease burden.
The research further suggests that vigorous exercise might be protective for the one in five testicular cancer survivors who suffered from the more severe side effects, Kerns said. She and Fung are involved in a pilot study at Wilmot testing the feasibility of exercise to reduce the side effects associated with testicular cancer chemotherapy.
The research is a collaborative effort by multiple institutions, and led by Lois Travis, M.D., of the Indiana University Melvin and Bren Simon Cancer Center. The team’s work dates back to 2012 when the National Cancer Institute awarded more than $5 million to identify genetic markers for patients most likely to suffer the debilitating side effects of platinum-based chemotherapy. Since then, the team has raised awareness of the long-term risks and discovered markers for neuropathy and hearing loss. The search continues for additional genetic markers associated with severe side effects.