Oral Presentation COSA-IPOS Joint Scientific Meeting 2012

Losing your marble(s): A cross-sectional study of psychosocial outcomes in Australian testicular cancer survivors (#55)

Allan B Smith 1 , Madeleine King 1 2 , Phyllis Butow 1 , Tim Luckett 3 , Peter Grimison 2 4 , Guy Toner 2 5 , Martin Stockler 2 4 , Elizabeth Hovey 2 6 , John Stubbs 2 7 , Ian Olver 8
  1. PoCoG, School of Psychology, University of Sydney, Sydney, Australia
  2. Australian New Zealand Urogenital and Prostate Cancer Trials Group (ANZUP), Sydney, Australia
  3. ImPaCCT, South Western Sydney Clinical School, The University of New South Wales, Sydney, Australia
  4. Sydney Cancer Centre, Sydney, Australia
  5. Peter MacCallum Cancer Centre, Melbourne, Australia
  6. Prince of Wales Hospital, Sydney, Australia
  7. Cancer Voices Australia, Sydney, Australia
  8. Cancer Council Australia, Sydney, Australia

Although >95% of men with testicular cancer (TC) are cured, many experience ongoing physical and psychological effects related to diagnosis and treatment. This large study is the first to use a validated measure of TC-specific quality of life (QOL) to assess the long-term sequelae of TC.

Aims: To determine the prevalence/severity and correlates of impaired QOL, psychological distress, and unmet needs in Australian TC survivors.

Methods: Men who had completed active treatment for TC 0.5-5 years previously, showing no evidence of recurrence, were recruited from 14 Australian cancer centres. Participants completed a questionnaire measuring demographics, disease and treatment information, general (SF36v2) and TC-specific (EORTC QLQ-TC26) QOL, psychological distress (DASS21) and unmet needs (CaSUN).

Results: 244 of 486 eligible TC survivors participated. Compared to age-adjusted Australian general population norms, TC survivors an average of 2.3 years post-treatment reported significantly higher levels of depression (p=.003, mean difference = 2.43, 95%CI .82,4.04) and anxiety (p=.007, mean difference = 2.46, 95%CI .69,4.24), lower mental QOL (p<.001, mean difference = -6.85 95%CI -8.47,-5.24) and marginally higher physical QOL (p=.036, mean difference = .99, 95%CI .07,1.91). The most commonly reported TC-specific QOL issues were anxiety about cancer recurrence and the future generally, plus the impact of TC on sexuality and fertility. Almost a quarter (22-23%) of TC survivors reported unmet needs relating to these issues. Variables most strongly associated with outcomes were: a helpless/hopeless adjustment style with depression (p<.001, B=1.27, 95%CI .89,1.65) and poorer mental QOL (p<.001, B=-1.23, 95%CI -1.83,-.63); more severe treatment side effects with anxiety (p<.001, B=.14, 95%CI .09,.20); and more job problems with poorer physical QOL (p<.001, B=-.12, 95%CI -.17,-.07).

Conclusions: Australian TC survivors have relatively good physical QOL, but suffer from ongoing impaired mental QOL and psychological distress. Effective management of side effects and intervention to reduce helplessness/hopelessness may facilitate better adjustment.