Losing your marble(s): A cross-sectional study of psychosocial outcomes in Australian testicular cancer survivors (#55)
Although >95% of men with testicular cancer (TC) are cured, many experience ongoing physical and psychological effects related to diagnosis and treatment. This large study is the first to use a validated measure of TC-specific quality of life (QOL) to assess the long-term sequelae of TC.
Aims: To determine the prevalence/severity and correlates of impaired QOL, psychological distress, and unmet needs in Australian TC survivors.
Methods: Men who had completed active treatment for TC 0.5-5 years previously, showing no evidence of recurrence, were recruited from 14 Australian cancer centres. Participants completed a questionnaire measuring demographics, disease and treatment information, general (SF36v2) and TC-specific (EORTC QLQ-TC26) QOL, psychological distress (DASS21) and unmet needs (CaSUN).
Results: 244 of 486 eligible TC survivors participated. Compared to age-adjusted Australian general population norms, TC survivors an average of 2.3 years post-treatment reported significantly higher levels of depression (p=.003, mean difference = 2.43, 95%CI .82,4.04) and anxiety (p=.007, mean difference = 2.46, 95%CI .69,4.24), lower mental QOL (p<.001, mean difference = -6.85 95%CI -8.47,-5.24) and marginally higher physical QOL (p=.036, mean difference = .99, 95%CI .07,1.91). The most commonly reported TC-specific QOL issues were anxiety about cancer recurrence and the future generally, plus the impact of TC on sexuality and fertility. Almost a quarter (22-23%) of TC survivors reported unmet needs relating to these issues. Variables most strongly associated with outcomes were: a helpless/hopeless adjustment style with depression (p<.001, B=1.27, 95%CI .89,1.65) and poorer mental QOL (p<.001, B=-1.23, 95%CI -1.83,-.63); more severe treatment side effects with anxiety (p<.001, B=.14, 95%CI .09,.20); and more job problems with poorer physical QOL (p<.001, B=-.12, 95%CI -.17,-.07).
Conclusions: Australian TC survivors have relatively good physical QOL, but suffer from ongoing impaired mental QOL and psychological distress. Effective management of side effects and intervention to reduce helplessness/hopelessness may facilitate better adjustment.