Factors Contributing to Mortality and Second Cancer Incidence After Treatment for Testicular Cancer

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In a Norwegian study reported in the Journal of Clinical Oncology, Fosså et al identified factors associated with increased mortality and second cancer risk among testicular cancer survivors, including treatment factors and modifiable adverse health outcomes.

Study Details

The study included data from 775 long-term testicular cancer survivors from the Cancer Registry of Norway treated for unilateral testicular cancer between 1980 and 1994. Patients were assessed according to whether they received surgery (n = 272) or platinum-based chemotherapy (n = 503), with the latter divided into those who received a total cisplatin dose of ≤ 630 mg (platinum-based chemotherapy–standard group, n = 124) or > 630 mg (platinum-based chemotherapy–high group, n = 379). Risks of 20-year mortality and second non–germ cell cancers were assessed according to such nonmodifiable factors as age, treatment, and prior major physical comorbidity, and modifiable adverse health outcomes such as low socioeconomic status, unhealthy lifestyle, depressive disorder disorder, and neurotoxicity.

Key Findings

Among all testicular cancer survivors, the cumulative overall 20-year mortality was 14% (95% confidence interval [CI] = 11.8%–16.8%).

On multivariate analysis, significant increases in risk were found for:

  • Increasing age for overall mortality (hazard ratio [HR] = 1.08), cancer mortality (subdistribution HR [sHR] = 1.07), and second cancer (sHR = 1.07)
  • Platinum-based chemotherapy–high vs no chemotherapy for overall mortality (HR = 1.97), cancer mortality (sHR = 3.65), and second cancer (sHR = 1.51)
  • Prior major comorbidity with overall mortality (HR = 1.93)
  • Low socioeconomic status with overall mortality (HR = 1.97)
  • Unhealthy lifestyle with overall mortality (HR = 1.65)
  • Depressive disorder with overall mortality (HR = 1.86), cancer mortality (sHR = 2.21), and second cancer (sHR = 2.06). 

In analysis according to adverse health outcome risk groups (excluding neurotoxicity as an adverse health outcome) that compared medium-risk (1–2 adverse health outcomes, n = 278) and high-risk groups (3 adverse health outcomes, n = 47) with a low-risk group (0 adverse health outcomes, n = 446), significant increases in risk were found for overall mortality in the medium-risk group (HR = 1.83) and high-risk group (HR = 8.73) and cancer mortality in the high-risk group (sHR = 5.44). No effect on risk of second cancer was observed.

The investigators concluded, “Self-reported unfavorable modifiable adverse health outcomes concerning lifestyle and psychosocial health are in testicular cancer survivors independently and significantly associated with increased overall mortality and cancer mortality. Health professionals and the testicular cancer survivors themselves, particularly those [who received] platinum-based chemotherapy–high [treatment], should continuously be aware of these risk factors attempting maximal reduction of these adverse health outcomes and thereby supporting long-term survival.”

Sophie D. Fosså, PhD, of the Department of Oncology, Oslo University Hospital, is the corresponding author for the Journal of Clinical Oncology article.

Disclosure: The study was supported by a Radium Hospital Foundation grant. For full disclosures of the study authors, visit

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.