Cazzaniga Walter, Kinsella Janette, Pearce Adam Kieran, Moghul Masood, Fox Louis, Van Hemelrijck Mieke, Reid Alison, Huddart Robert, Nicol David
Department of Uro-Oncology, The Royal Marsden NHS Foundation Trust, London, United Kingdom.
Urology Department, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia.
Front Urol. 2023 Jul 31;3:1174626. doi: 10.3389/fruro.2023.1174626. eCollection 2023.
Despite the excellent long-term prognosis after treatment for testicular cancer (TCa), therapy-related side effects can be persistent and severe. The aim of this study was to determine the nature and prevalence of post-treatment symptoms and their impact on health-related quality of life (HRQoL) in TCa patients 12 to 24 months after treatment.
Cross-sectional, single-center study. All patients who were aged 18 and over, had completed TCa treatment 12-24 months previously and had no evidence of disease recurrence were considered eligible. Participants were stratified into four groups: 1) orchidectomy only; 2) orchidectomy and single dose adjuvant carboplatin; 3) multi-agent induction chemotherapy (CBOP-BEP, BEPx3 or x4, or Epx4 regimens); and 4) post-chemo retroperitoneal lymph node dissection (PC-RPLND). Eligible patients were asked to complete the EQ-5D-5L questionnaire and the EORTC QLQ-TC26 questionnaire. We performed a thematic analysis of free-text commentary to evaluate the sensitivity of PROMs used across the treatment groups. Descriptive results were reported. For categorical variables, numbers and percentages were used, and for continuous variables median and IQR values were used.
The EQ-5D-5L questionnaire showed that patients treated with orchidectomy only and orchidectomy and adjuvant carboplatin experienced only minor physical medium- to long-term side-effects. In contrast, more intensive treatment regimens, such as multi-agent chemotherapy or PC-RPLND, were associated with a higher burden of medium- to long-term side-effects. Similar results were obtained with the EORTC QLQ-TC26 questionnaire.
This study reports the medium- to long-term HRQoL and side effects of TCa treatments, using both EQ-5D-5L and EORTC QLQ-TC26 questionnaires, and identifies possibly "unasked" questions from a patient perspective in relation to supportive care needs following TCa treatment. This information will help clinicians to better understand the consequences of treatment and in turn provide better patient counseling before treatment.
尽管睾丸癌（TCa）治疗后的长期预后良好，但治疗相关的副作用可能持续且严重。本研究的目的是确定治疗后12至24个月的TCa患者治疗后症状的性质和患病率及其对健康相关生活质量（HRQoL）的影响。
横断面单中心研究。所有年龄在18岁及以上、在12 - 24个月前完成TCa治疗且无疾病复发证据的患者被认为符合条件。参与者被分为四组：1）仅行睾丸切除术；2）睾丸切除术加单剂量辅助卡铂；3）多药诱导化疗（CBOP - BEP、BEPx3或x4、或Epx4方案）；4）化疗后腹膜后淋巴结清扫术（PC - RPLND）。符合条件的患者被要求完成EQ - 5D - 5L问卷和欧洲癌症研究与治疗组织（EORTC）QLQ - TC26问卷。我们对自由文本评论进行了主题分析，以评估各治疗组使用的患者报告结局量表（PROMs）的敏感性。报告了描述性结果。对于分类变量，使用了数字和百分比，对于连续变量，使用了中位数和四分位间距值。
EQ - 5D - 5L问卷显示，仅行睾丸切除术以及睾丸切除术加辅助卡铂治疗的患者仅经历轻微的中长期身体副作用。相比之下，更强化的治疗方案，如多药化疗或PC - RPLND，与更高的中长期副作用负担相关。EORTC QLQ - TC26问卷也得到了类似结果。
本研究使用EQ - 5D - 5L和EORTC QLQ - TC26问卷报告了TCa治疗的中长期HRQoL和副作用，并从患者角度识别了TCa治疗后支持性护理需求方面可能“未被问到”的问题。这些信息将帮助临床医生更好地理解治疗的后果，进而在治疗前为患者提供更好的咨询。
