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Cardiovascular Disease in Testicular Cancer Survivors: Identification of Risk Factors and Impact on Quality of Life
Sjoukje Lubberts1, Harmke J Groot2, Ronald de Wit3
1Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
Insights
Testicular cancer survivors face increased cardiovascular disease risk, especially those treated with chemotherapy or with risk factors like obesity and smoking. Early lifestyle changes and lifelong monitoring are crucial for managing these risks and improving quality of life.
Area of Science:
- Oncology
- Cardiology
- Public Health
Background:
- Testicular cancer (TC) treatment is linked to significant cardiovascular morbidity and mortality.
- Understanding cardiometabolic risk factors and quality of life (QoL) in TC survivors is essential for developing preventive strategies.
Purpose of the Study:
- To assess cardiometabolic risk factors and QoL in testicular cancer survivors.
- To identify factors associated with increased cardiovascular disease (CVD) risk post-TC treatment.
Main Methods:
- A multicenter cohort of 4,748 TC patients (treated 1976-2007, age 12-50) was analyzed for CVD incidence.
- Questionnaires and clinical evaluations assessed cardiometabolic risk factors and QoL in a subcohort of survivors.
Main Results:
- Cisplatin chemotherapy, obesity, smoking, Raynaud's phenomenon, dyslipidemia, and family history increased CVD risk.
- TC survivors with CVD reported lower QoL. High prevalence of dyslipidemia (86%), hypertension (50%), and metabolic syndrome (35%) was observed in evaluated survivors.
Conclusions:
- Cardiovascular events negatively impact TC survivors' QoL.
- Many TC survivors have undetected cardiovascular risks.
- Advocating for early lifestyle adjustments and lifelong follow-up with prompt treatment of risk factors is recommended, particularly for platinum-chemotherapy treated, obese, and smoking patients.
Purpose:
Testicular cancer (TC) treatment is clearly associated with cardiovascular morbidity and mortality. To enable development of preventive strategies for cardiovascular disease (CVD), we assessed cardiometabolic risk factors and quality of life (QoL) in TC survivors.
Methods:
Incidence of coronary artery disease, myocardial infarction, and heart failure after TC treatment was assessed in a multicenter cohort comprising 4,748 patients treated at the age of 12-50 years between 1976 and 2007. Patients who had developed CVD and a random sample from the cohort (subcohort) received a questionnaire on cardiometabolic risk factors and QoL. A subgroup of responders in the subcohort additionally underwent clinical evaluation of cardiovascular risk factors.
Results:
After a median follow-up of 16 years, 272 patients had developed CVD. Compared with orchidectomy only, cisplatin combination chemotherapy was associated with an increased CVD risk (hazard ratio [HR], 1.9; 95% CI, 1.1 to 3.1). Patients who were obese or a smoker at diagnosis (HR, 4.6; 95% CI, 2.0 to 10.0 and HR, 1.7; 95% CI, 1.1 to 2.4, respectively), developed Raynaud's phenomenon (HR, 1.9; 95% CI, 1.1 to 3.6) or dyslipidemia (HR, 2.8; 95% CI, 1.6 to 4.7) or had a positive family history for CVD (HR, 2.9; 95% CI, 1.7 to 4.9) had higher CVD risk. More TC survivors with CVD reported inferior QoL on physical domains than survivors who did not develop CVD. Of 304 TC survivors who underwent clinical evaluation for cardiovascular risk factors (median age at assessment: 51 years), 86% had dyslipidemia, 50% had hypertension, and 35% had metabolic syndrome, irrespective of treatment.
Conclusion:
Cardiovascular events in TC survivors impair QoL. Many TC survivors have undetected cardiovascular risk factors. We advocate early lifestyle adjustments and lifelong follow-up with low-threshold treatment of cardiovascular risk factors, especially in obese and smoking patients treated with platinum-based chemotherapy.
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