Nearly 4 years after completion of chemotherapy, a subset of survivors of testicular cancer continued to experience cisplatin-related adverse health outcomes (AHOs), which were associated with higher rates of unemployment and disability leave, according to a prospective observational study.

The most common cancer among men aged 18 to 39 years, testicular cancer is typically diagnosed when men are preparing to enter, or recently entered, the workforce. Therefore, this study sought to understand how testicular cancer treatment could affect the ability of an individual to work.

The study included 1815 men who had completed chemotherapy at least 1 year prior for testicular cancer. Patients completed questionnaires about AHOs and employment; answers were compared with those from a similar normative population.

At the time of analysis, the median respondent age was 37 years, 88% were white, 64% were college-educated, 81% were employed full-time, 6.8% were unemployed, and 2.4% were on disability leave. The median time since last chemotherapy treatment was 3.8 years (range, 1-35 years) and a majority of patients received standard multiagent chemotherapy regimens, which included cisplatin.


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Compared with population norms, testicular cancer survivors were significantly more likely to be unemployed (age-adjusted odds ratio [OR], 2.67; 95% CI, 2.49-3.02; P <.001).

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Patients who were on disability leave were significantly more likely to be experiencing peripheral sensory neuropathy (OR, 2.89; 95% CI, 1.01-8.26; P =.048), renal dysfunction (OR, 12.1; 95% CI, 2.06-70.8; P =.01), pain (OR, 10.6; 95% CI, 4.4-25.4; P <.001), and a higher cumulative burden morbidity score (CBMPt; OR, 1.46; 95% CI, 2.03-2.08; P =.03).

Similarly, patients who were unemployed also experienced higher rates of AHOs, including peripheral sensory neuropathy (OR, 2.44; 95% CI, 1.28-4.62; P =.006), patient-reported hearing loss (OR, 1.82; 95% CI, 1.04-3.17; P =.04), and pain (OR, 3.75; 95% CI, 2.06-6.81; P <.001).

Although most testicular cancer survivors reported good health and were employed nearly 4 years after completing treatment, the authors said that a “small group experiences multiple cisplatin-related AHOs, often severe, which are associated with disability-leave, unemployment, and worse self-reported health.” This is important because, “an awareness of AHOs associated with disability leave can help focus efforts in developing interventions/strategies to ameliorate/prevent these outcomes,” the authors said.

Reference

Kerns SL, Fung C, Fossa SD, et al. Relationship of cisplatin-related adverse health outcomes with disability and unemployment among testicular cancer survivors [published online March 20, 2020]. JNCI Cancer Spectrum. doi: 10.1093/jncics/pkaa022