Age-related variation and predictors of long-term quality of life in germ cell tumor survivors

doi:10.1016/j.urolonc.2015.09.005

Urologic Oncology: Seminars and Original Investigations

Volume 34, Issue 2, February 2016, Pages 60.e1-60.e6

https://doi.org/10.1016/j.urolonc.2015.09.005 Get rights and content

Highlights

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Men who survived germ cell tumors can expect a normal quality of life overall.
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Their mental quality of life was significantly lower.
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Patients in their 30s and 40s were particularly affected.
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Reliable predictors of this variation remain to be identified.

Abstract

Purpose

To compare long-term health-related quality of life (QoL) in germ cell tumor survivors (GCTS) and age-adjusted men and to identify predictors of variation in long-term QoL in GCTS.

Methods

We used the Short-Form Health Survey to measure QoL in a cross-sectional sample of 164 survivors of germ cell tumors from Hamburg, Germany. QoL was compared with age-adjusted German norm data. Sociodemographic and medical data from questionnaires and medical records were used to find predictors of QoL.

Results

On average, patients were 44.4 years old (standard deviation = 9.6 y) and average time since first germ cell tumor diagnosis was 11.6 years (standard deviation = 7.3 y). We found significantly lower mental component scores in GCTS when compared with norm data (Hedges g =−0.44, P<0.001). An exploratory analysis by age group showed the largest difference in mental QoL in survivors aged 31 to 40 years (Hedges g =−0.67). Linear regression analysis revealed age (β =−0.46, P<0.001), marital status (β = 0.20, P = 0.024), advanced secondary qualifications (β =−0.25, P = 0.001), time since diagnosis (β = 0.17, P = 0.031), and tumor stage (β = 0.17, P = 0.024) as statistically significant predictors of the physical component score, accounting for 22% of the variance. Statistically significant predictors of the mental component score were higher secondary qualifications (β = 0.17, P = 0.033) and unemployment (β =−0.21, P = 0.009), accounting for 6% of the variance.

Conclusions

Survivors of germ cell tumors can expect an overall long-term QoL similar to that of other men of their age.

Introduction

Today, more than 95% of patients with germ cell tumor are cured because of advances in diagnosis and treatment such as cisplatin-based chemotherapy [1]. Patients having germ cell tumors are relatively young at first diagnosis (typically between 20 and 45 y) and can live on for decades after successful tumor treatment. Therefore, data on long-term impairment of quality of life (QoL) are of particular relevance. In germ cell tumor survivors (GCTS), the risk for premature metabolic syndrome and second malignancies as well as cardiovascular, renal, neurological, and pulmonary late toxicities has been well known for years [2], [3].

It has repeatedly been found that GCTS’ overall health-related QoL is comparable to that of age-adjusted men in the long term [4], [5], [6]. Significant decreases in QoL have been observed mainly within the first year after diagnosis [7].

However, predictors of variation in long-term QoL remain to be identified. Most studies were not able to detect effects of treatment modalities on long-term QoL [6], [8], but the results have been somewhat heterogeneous. Kim et al. [9] found that only patients treated with chemotherapy showed significantly lower QoL 5 years after first diagnosis. Contrary to that, Mykletun et al. [8] found that long-term side effects and cancer-related (posttraumatic) stress, but not treatment modality, partly accounted for variation in QoL.

Other identified risk factors of low QoL, such as physical symptoms, chronic fatigue, or unemployment combined with an additional chronic disease, tend to be part of the QoL construct or unspecific to GCTS [10], [11].

This cross-sectional study therefore aimed to (1) compare the QoL of GCTS and age-adjusted men in the long term and (2) identify predictors of variation in long-term QoL in GCTS.

Section snippets

Patients and procedures

In this cross-sectional study, we enrolled adult male patients with germ cell cancer from the outpatient ward of the University Medical Center within the University Cancer Center Hamburg and a specialized private practice in Hamburg, Germany. All patients with a histologically confirmed diagnosis of GCT who were treated during the follow-up period at these 2 institutions in October 2012 were eligible for study participation if they had completed antitumor treatment at least 12 months prior

Patient characteristics

Of the 255 eligible patients approached, 164 (64.3%) completed the questionnaire. Participants and nonparticipants did not differ in age (P = 0.18), years since diagnosis (P = 0.39), and presence of metastases at first diagnosis (P = 0.98). Table 1 shows participating patients’ demographic and medical characteristics.

QoL comparisons with norm data

Sample and norm data on QoL (SF-8 scores) are compared in Table 2. We found statistically significantly lower mental component scores in patients for the total sample (g =−0.44, P

Age-related variations in QoL

Our results show that GCTS can still have a detectably lower mental QoL several years after curative treatment. However, considering that none of the absolute SF-8 scores were less than 47, these differences in QoL themselves may not be of clinical relevance. This is in line with previous studies that found no significant differences in overall QoL [4], [5], [6].

Our exploratory comparison of age groups shows the largest difference in mental QoL in patients aged 31 to 40 years (Hedges g =−0.67).

Conclusions

GCTS can expect similar overall QoL as that of other men of their age. In addition, better hypotheses are required to aid the search for relevant predictors of mental QoL in GCTS and to determine their clinical relevance.

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Original articleAge-related variation and predictors of long-term quality of life in germ cell tumor survivors

Highlights

Abstract

Purpose

Methods

Results

Conclusions

Introduction

Section snippets

Patients and procedures

Patient characteristics

QoL comparisons with norm data

Age-related variations in QoL

Conclusions

Eur Urol

Urol Oncol

Urology

J Psychosom Res

Econ Lett

Soc Sci Med

Long-term and late effects of germ cell testicular cancer treatment and implications for follow-up

J Clin Oncol

Original article
Age-related variation and predictors of long-term quality of life in germ cell tumor survivors