Modifiable adverse health outcomes (AHOs) affect overall mortality and cancer mortality in testicular cancer survivors (TCSs) but have no effect on second cancer incidence, according to research published in the Journal of Clinical Oncology.

Researchers explored the association between physical and psychosocial AHOs and overall mortality, cancer mortality, and second cancer incidence using data from the Norwegian Testicular Cancer Project.

Nearly 1000 patients with testicular cancer treated at 1 of 4 Norwegian university hospitals from 1999 through 2001 were invited to participate in a longitudinal survey. The survey consisted of 3 waves of a mailed questionnaire and a clinical examination. This study is based on the responses to the questionnaire in the first wave.

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The questionnaire was completed by 775 TCSs. Of the respondents, 272 had undergone surgery and 503 had received platinum-based chemotherapy (PBCT). Those who received PBCT were further separated into a standard group (total cisplatin, ≤630 mg; 124 TCSs) and a high group (total cisplatin, >630 mg; 379 TCSs).

For this study, modifiable AHOs were low socioeconomic status (SES), probable depressive disorder, neurotoxicity, and unhealthy lifestyle. Nonmodifiable AHOs included age, treatment, and major comorbidity (diabetes, previous myocardial infarction, or stroke) reported in the first survey.

The prevalence of modifiable AHOs was highest in the PBCT-high group compared with the PBCT-standard and surgery groups (low SES, 23% vs 17% vs 15%; unhealthy lifestyle, 30% vs 30% vs 24%; neurotoxicity, 49% vs 33% vs 31%, respectively).

The risk of overall mortality was almost double for TCSs who reported 1 or 2 AHOs, compared with TCSs who reported no AHOs. The risk of overall mortality and cancer mortality was increased 8-fold and 5-fold, respectively, in TCSs who reported 3 AHOs.

“Health professionals and the TCSs themselves, particularly those after PBCT high, should repeatedly be made aware of these risk factors,” the researchers advised.

A potential limitation of this study may be a lack of generalizability of these findings because TCSs who underwent primary radiotherapy were excluded, as this treatment is no longer standard therapy for testicular cancer in many countries. Other potential limitations are that the AHOs were patient-reported, and reduced cumulative cisplatin doses may have resulted in fewer AHOs among more recently treated TCSs.


Fossa SD, Dahl AA, Thorsen L, et al. Mortality and second cancer incidence after treatment for testicular cancer: psychosocial health and lifestyle are modifiable prognostic factors. J Clin Oncol. Published online April 5, 2022. doi:10.1200/JCO.21.02105

This article originally appeared on Oncology Nurse Advisor