Cardiovascular Disease in Survivors of Testicular Cancer

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In a Dutch study reported in the Journal of Clinical Oncology, Lubberts et al identified risk factors for cardiovascular disease among survivors of testicular cancer and assessed the impact of cardiovascular disease on quality of life.

Study Details

The study involved data from a multicenter cohort of 4,748 patients treated at age 12–50 years between 1976 and 2007. Cardiovascular disease was defined as coronary artery disease, myocardial infarction, or heart failure. Patients who developed cardiovascular disease and a random sample of patients from the remaining cohort who did not develop cardiovascular disease received a questionnaire on cardiometabolic risk factors and quality of life. A subgroup of patients who did not develop cardiovascular disease underwent clinical evaluation for cardiovascular risk factors.

Key Findings

After median follow-up of 16 years, 272 patients had developed cardiovascular disease. Compared with orchiectomy only, cisplatin combination chemotherapy was associated with increased cardiovascular disease risk (hazard ratio [HR] = 1.9, 95% confidence interval [CI] = 1.1–3.1), with risk further increased in patients who also received radiotherapy (HR = 2.5, 95% CI = 1.2–5.1). Treatment with radiotherapy alone was not associated with increased cardiovascular disease risk (HR = 1.1, 95% CI = 0.6–1.9).  

Patients who developed cardiovascular disease were older at testicular cancer diagnosis vs those who did not (median age = 35.6 vs 30.7 years, P < .0001). Other factors associated with increased risk of cardiovascular disease were obesity at diagnosis (HR = 4.6, 95% CI = 2.0–10.0), being a smoker at diagnosis (HR =1.7, 95% CI = 1.1–2.4), development of Raynaud’s phenomenon (HR = 1.9, 95% CI = 1.1–3.6), development of dyslipidemia (HR = 2.8, 95% CI = 1.6–4.7), and family history of cardiovascular disease (HR = 2.9,  95% CI = 1.7–4.9).

On quality-of-life assessment, compared with patients who did not develop cardiovascular disease, those who developed cardiovascular disease reported lower physical functioning (P < .001), less energy and vitality (P = .002), more bodily pain (P = .036), more fatigue (P = .003), and lower general health score (P < .001).

Among 304 survivors without cardiovascular disease who underwent clinical evaluation for cardiovascular risk factors (median follow-up of 22 years after cancer diagnosis; median age at assessment = 51 years), 86% had dyslipidemia, 50% had hypertension, and 35% had metabolic syndrome, irrespective of treatment.

The investigators concluded: “Cardiovascular events in [testicular cancer] survivors impair [quality of life]. Many [testicular cancer] 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.”

Jourik A. Gietema, MD, PhD, University Medical Center Groningen, University of Groningen, the Netherlands, is the corresponding author for the Journal of Clinical Oncology article.

Disclosure: The study was supported by the Dutch Cancer Society. For full disclosures of the study authors, visit


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