Health-Related Quality of Life Following Treatment for Testicular Cancer: A Qualitative Systematic Review

Testicular cancer (TCa) can precipitate ongoing psychosocial/physical morbidity post-treatment, despite high rates of cure. We conducted a systematic review to synthesise three decades of primary qualitative research on health-related quality of life (HRQoL) to inform the design of supportive care pathways. We queried MEDLINE/PubMed, PsycINFO, CINAHL, and Web of Science for all qualitative studies published up to 26 October 2022 examining issues relevant to HRQoL in post-treatment TCa patients. Two independent reviewers appraised included studies for methodological quality using established guidance for evidence-based public health policy and analysed findings via thematic synthesis. Studies were analytically weighted by study quality. Studies were evaluated using GRADE-CERQual to produce confidence levels in findings. We included 18 studies, comprising 387 participants. Seven studies were graded high quality, eight medium quality, and three low quality. Emergent analytical themes were: (a) Residual psychological injury; (b) Information deficits and unnecessary anxiety; (c) Thwarted life trajectory; (d) Social disruption; (e) Undermined youth; (f) Health service abandonment; (g) Long-term sexual problems; and (h) Maladaptive coping and post-traumatic stress. All findings were deemed 'high confidence', except theme (g), which was of 'moderate confidence'. A limitation of the review was the relative dominance of Anglophone countries in the included studies. Some men treated for TCa are at risk of a range of post-treatment HRQoL issues, particularly psychosocial issues. Some individuals may be more at risk than others, based on specific personality traits, access to accurate and complete information about treatment recovery, and individual coping responses.