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Treatment not testicular cancer poses greatest risk to survivors' long-term health

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  • Treatment not testicular cancer poses greatest risk to survivors' long-term health

    Note: I am able to access the entire TC special issue of BJUI table of contents and full text of the articles here: http://www3.interscience.wiley.com/j...22649052/issue . Very timely and interesting articles.

    Treatment not testicular cancer poses greatest risk to survivors' long-term health

    Thursday, 15 October 2009
    OXFORD, UK (Press Release) - October 15, 2009 - Testicular cancer survivors can face an increased risk of long-term illness, not because of the malignancy, but the highly effective treatment they receive, according to a study in the urology journal BJUI.

    Researchers from the Norwegian Radium Hospital at the University of Oslo found that the number of problems faced by survivors are higher than generally thought, because clinicians only report those that are life-threatening or require medical intervention. Awareness of this discrepancy has led to a greater focus on patient-reported outcomes.

    The research review, part of a November BJUI special issue on testicular cancer, shows that as many as a quarter of survivors develop long-term neurological, hearing and circulation problems and they are twice as likely to develop a secondary cancer. On a more positive note, up to 80 per cent who attempt to become fathers after treatment are successful.

    "Patients can suffer considerable mental distress after having one testicle removed due to cancer, but this gradually decreases with treatment" says lead author Professor Sophie D Fossa.

    "Gastrointestinal side-effects are common during both chemotherapy and radiotherapy and chemotherapy carries added risks like infections and blood clots. Long-term problems include secondary cancers, heart problems, and conditions related to lower hormone levels.

    "We believe that the best way to reduce the short and long-term health of survivors is to reduce the risk, by smoking cessation, physical activity and weight reduction, and to provide adequate follow-up for patients who could develop life-threatening toxicity."

    Key findings from the review, which covered 40 studies published between 1990 and 2008, included:
    • About 80 per cent of men who have one testicle removed continue to produce sperm, often at reduced levels, and although men are advised to freeze their semen before treatment, less than 10 per cent use their frozen samples later on.
    • Pulmonary complications can arise in men who receive the drug bleomycin before larger surgical procedures, particularly if they are aged 40 or over.
    • Radiotherapy can cause short-term nausea, vomiting and lethargy, but side-effects tend to decrease two to four weeks after therapy.
    • Cisplatin-based chemotherapy can damage the sensory nerves in 10 to 30 per cent of patients and 20 per cent of survivors complain of impaired hearing and tinnitus.
    • Most acute drug toxicity problems tend to resolve themselves, or decrease, in the first year, but long-term problems pose greater issues. Despite this, many patients are only monitored by their consultant for five to ten years, after which they may or may not be regularly seen by primary care professionals.
    • Survivors are up to 1.8 times more likely to develop a secondary cancer, particularly solid malignancies below the diaphragm. The introduction of cisplatin-based chemotherapy, and a gradual reduction in radiotherapy, does not appear to have reduced the secondary cancer risk. But it appears to reduce the risk of cancer developing in the remaining testicle.
    • Avoiding mediastinal radiotherapy has reduced the risk of chronic heart complications, but death rates are still slightly increased by infra-diaphragmatic radiotherapy. In addition, the chemotherapy drug cisplatin can cause inflammation of the endothelial cells, leading to premature thickening of the coronary arteries.
    • About 20 per cent of survivors have already suffered irreversible hypogonadism, where the testes produces little or no sex hormone, and reduced fertility before their cancer is diagnosed.
    • Removal of lymph nodes in the abdomen can lead to dry ejaculation in some patients and infra-diaphragmatic radiotherapy and chemotherapy can cause temporary reductions in fertility.
    • Surprisingly, survivors report similar health-related quality of life to age-matched controls. However these measures do not cover body image and masculinity, issues that have been inadequately researched. It is suggested that survivors adapt to their new situation and take their cancer into account when rating their quality of life.
    • Anxiety levels are increased and are significantly associated with young age, peripheral neuropathy, economic problems, alcohol problems, sexual problems, fear of reoccurrence and having been treated for mental problems. Findings on depression are contradictory, but links between higher levels of depression and unhealthy lifestyles, particularly smoking, need urgent investigation.
    • About 17 per cent of survivors suffer chronic fatigue, almost twice the normal population, and this is associated with a wide range of factors, including older age, greater economic and sexual problems and poorer physical and mental health.
    • Sexual functioning is similar to age-matched controls, possibly because survivors adapt to their post cancer life. However survivors who have had the lymph nodes removed in their abdomen can experience more ejaculation problems.
    • Work is important for survivors' health-related quality of life and, at least in Norway, they have the same living conditions, job stress and work engagement as age-matched controls, despite their poorer physical work ability.

    "Current patients with testicular cancer should be informed about the risk of short-term and particularly long-term side-effects of their highly effective treatment" concludes Professor Fossa.

    "It is important to focus on reducing risks through healthy lifestyle choices and consider important issues like preserving future fertility.

    "We would also like to see screening guidelines developed to ensure that the long-term side-effects are diagnosed and treated as early as possible."


    ###

    Notes to editors

    Short and long-term morbidity after treatment for testicular cancer. Fossa S D, Oldenburg J and Dahl AA. BJUI. 104, 1418-1422. (November 2009). doi:10.1111/j.1464-410X.2009.08869.x

    Established in 1929, BJUI is published 23 times a year by Wiley-Blackwell and edited by Professor John Fitzpatrick from Mater Misericordiae University Hospital and University College Dublin, Ireland. It provides its international readership with invaluable practical information on all aspects of urology, including original and investigative articles and illustrated surgery. www.bjui.org.

    Wiley-Blackwell is the international scientific, technical, medical and scholarly publishing business of John Wiley & Sons, with strengths in every major academic and professional field and partnerships with many of the world's leading societies. Wiley-Blackwell publishes over 1,400 peer-reviewed journals as well as 1,500+ new books annually in print and online, as well as databases, major reference works and laboratory protocols. For more information, please visit www.wileyblackwell.com or www.interscience.wiley.com

    British Journal of Urology International (BJUI)

    [ PRESS RELEASE ]
    Last edited by Paul54; 10-16-09, 09:22 AM.
    "Statistics are human beings with the tears wiped off" - Paul Brodeur
    Diagnosis: 05Sept07 Right I/O: 13Sept07; Pure Seminoma; Surveillance only per NCCN: All Clear August2013 (CT scan, Markers)

  • #2
    Does this mean I'm doomed?
    I wonder if the study took into account my super powers.
    If you look for the truth outside yourself, it gets farther and farther away. ~ Tung-Shan
    If you love life, don't waste time, for time is what life is made up of. ~ Bruce Lee
    Please sponsor me for the 2011 LiveSTRONG Challenge Philadelphia.
    My Blog

    Diagonosed 1988. Left I/O - 3 rounds of chemo
    Relasped 1989. RPLND - 3 rounds HDC - Bone Marrow transplant.
    There is Army Strong, There is Live Strong and then there is me. Crazy Strong

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    • #3
      Originally posted by Jay68442 View Post
      I wonder if the study took into account my super powers.
      Apparently not Bicycle Man!
      ML,
      The Tattooed Avenger!
      I Love My Pack!

      sigpic

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      • #4
        Very interesting study, thanks.
        100% classical seminoma (I-A, RTI). Surveillance (no adjuvant therapy). 4 years all-clear and hoping for many more.

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        • #5
          Survivors are up to 1.8 times more likely to develop a secondary cancer, particularly solid malignancies below the diaphragm. The introduction of cisplatin-based chemotherapy, and a gradual reduction in radiotherapy, does not appear to have reduced the secondary cancer risk. But it appears to reduce the risk of cancer developing in the remaining testicle.
          Does this refer only to survivors who had chemo/radiation, or to people on surveillance/RPLND as well?

          Either way, sobering thought.
          Let's Go Mets! sigh...

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          • #6
            Originally posted by NYC Russ View Post
            Does this refer only to survivors who had chemo/radiation, or to people on surveillance/RPLND as well?

            Either way, sobering thought.
            I'm going to read the paper end-to-end when I get a chance, but I'm pretty sure that statistic is an average across the entire spectrum of treatment including RPLND and surveillance.
            "Statistics are human beings with the tears wiped off" - Paul Brodeur
            Diagnosis: 05Sept07 Right I/O: 13Sept07; Pure Seminoma; Surveillance only per NCCN: All Clear August2013 (CT scan, Markers)

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            • #7
              I am Bicycle Man! The exception to the rule. I will not be hindered by no stinking cancer or secondary cancer for that matter. I'm too strong for that **** and will fight until the end. You will never take me alive. (sinister laugh goes here)

              All kidding aside I have often wondered about the long term effects all that chemo had on my body. I know in my later years I will have some things to deal with and that is why I always live for the moment. No better time than the present.
              If you look for the truth outside yourself, it gets farther and farther away. ~ Tung-Shan
              If you love life, don't waste time, for time is what life is made up of. ~ Bruce Lee
              Please sponsor me for the 2011 LiveSTRONG Challenge Philadelphia.
              My Blog

              Diagonosed 1988. Left I/O - 3 rounds of chemo
              Relasped 1989. RPLND - 3 rounds HDC - Bone Marrow transplant.
              There is Army Strong, There is Live Strong and then there is me. Crazy Strong

              Comment


              • #8
                Had a conversation with a colleauge who is also an 11 year survivor of Non-Hodgekins Lymphoma. We were discussing our Dr. visits and some of the potential "stuff" which can happen to us down the road. I came up with an analogy. We sit balanced between two windows. For each year we are NED -no evidence of disease within a ~5 year window we increase our chances of never getting our primary cancer again. Conversely, for each year we are NED -no evidence of disease within a ~5 to ~10 year window we increase our chances of getting a secondary cancer depending on treatment. Trick is we can still look out that window right now and see what's happening outside. Even if the glass is a little dirty.
                Much Love,
                Mark
                I Love My Pack!

                sigpic

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                • #9
                  Yeah... I have not read it through apart from what you posted. My only skepticism is that unfortunately getting TC and being cured does not preclude you from getting another cancer later or even sooner, that you would have gotten anyway, regardless of TC and whatever treatment regimen you followed. They have to back those out of the stats, for example a large number of men will develop colon or prostate cancer. As a matter of fact I read somewhere (here???) a hypothesis that all men would eventually develop prostate cancer if they lived long enough. Certainly don't know if that is true, but I would argue that the math behind the numbers needs to be understood as well if not better than the actual presentation.
                  Best,

                  Zsolt


                  Friendship is born at that moment when one person says to another; "What! You too? I thought I was the only one." - C.S Lewis

                  “Experience: that most brutal of teachers. But you learn, my God do you learn.” - C.S. Lewis


                  Mass found 11/20/08
                  Left I/O 11/25/08
                  Pathology: Seminoma, Stage 1
                  Surveillance: All Clear since

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                  • #10
                    I certainly did not post that to depress anybody. More of a head's up to watch your health and be more sensitive to the danger signs of other things cropping up. For me, this includes following my doctors recommendation that I get a colonoscopy every 3 years instead of the standard 5 years. That's a real nuisance (one might say a pain in the a$$ ha ha), but I intend to live a long time so this extra surveillance stuff is worth the price.

                    I still haven't had a chance to read the entire paper. I'd bet that the radiation dosing, better chemo drugs and refining the chemo dosing over the last decade or two have reduced the secondary cancer risks significantly. and we should be looking forward to the days when diagnosis is better and treatments more person-specific.
                    "Statistics are human beings with the tears wiped off" - Paul Brodeur
                    Diagnosis: 05Sept07 Right I/O: 13Sept07; Pure Seminoma; Surveillance only per NCCN: All Clear August2013 (CT scan, Markers)

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