Long-Term Risk of Alcohol Use Disorder in Testicular Cancer Survivors: A National Veterans Affairs Cohort Study

Testicular germ cell tumors are the most common solid malignancy in young men and are associated with high cure rates. Given the young age at diagnosis and prolonged survivorship, testicular cancer survivors (TCS) may be vulnerable to alcohol use disorder (AUD). We evaluated the incidence and predictors of AUD and examined whether chemotherapy increased risk.

We conducted a retrospective cohort study using the VA national healthcare system through the Veterans Informatics and Computing Infrastructure, identifying patients with testicular germ cell tumors from 1990-2021. A cancer-free comparison group was created using 1:5 exact matching on birth year and race, with assigned index dates. Patients with preexisting AUD were excluded. AUD was defined using ICD-9/10 diagnosis codes and alcohol-related CPT codes. Cox proportional hazards models assessed associations, adjusting for demographic and clinical variables. Cumulative incidence was estimated using Kaplan-Meier methods.

We identified 1,774 TCS and 3,224 matched controls. At 10 years, cumulative AUD incidence was 21.6% in TCS vs 1.5% in controls (HR 13.8, 95% CI 9.2-20.8, P < .001). Chemotherapy was not independently associated with AUD (HR 1.16, P = .26). Higher risk was observed with unemployment (HR 1.43, P = .001) and Black race (HR 1.60, P = .01), while never smoking was protective (HR 0.46, P < .001).

AUD risk is markedly elevated in TCS and is driven by sociodemographic factors rather than treatment exposure, highlighting the need for targeted screening and survivorship interventions.