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Fertility, gonadal and sexual function in survivors of testicular cancer.

Huddart RA, Norman A, Moynihan C, Horwich A, Parker C, Nicholls E, Dearnaley DP - Br. J. Cancer (2005)

Bottom Line: After treatment, compared to baseline, patients receiving chemotherapy had significantly greater elevations of FSH (median rise of 6 (IQR 3-9.25) iu l(-1) compared to 3 (IQR 1-5) iu l(-1) for S; P < 0.001) and a fall (compared to a rise in the surveillance group) in median testosterone levels (-2 (IQR -8.0 to -1.5) vs 1.0. (IQR -4.0-4.0) P < 0.001).Treatment was associated with reduction in sexual activity and patients receiving chemotherapy had more concerns about fathering children.Gonadal dysfunction reduces quality of life and has an adverse effect on patient health.

View Article: PubMed Central - PubMed

Affiliation: Academic Unit of Radiotherapy and Oncology, Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey SM2 5PT, UK. Robert.Huddart@icr.ac.uk

ABSTRACT
Modern treatments cure most testicular cancer patients, so an important goal is to minimise toxicity. Fertility and sexual functioning are key issues for patients. We have evaluated these outcomes in a cross-sectional study of long-term survivors of testicular cancer. In total, 680 patients treated between 1982 and 1992 completed the EORTC Qly-C-30(qc30) questionnaire, the associated testicular cancer specific module and a general health and fertility questionnaire. Patients have been subdivided according to treatment received: orchidectomy either alone (surveillance, S n = 169), with chemotherapy (C, n = 272), radiotherapy (R, n = 158), or both chemotherapy and radiotherapy (C/RT n = 81). In the surveillance group, 6% of patients had an elevated LH, 41% an elevated FSH and 11% a low (< 10 nmol l(-1)) testosterone. Hormonal function deteriorated with additional treatment, but the effect in general was small. Low testosterone was more common in the C/RT group (37% P = 0.006), FSH abnormalities were more common after chemotherapy (C 49%, C/RT 71% both P < 0.005) and LH abnormalities after radiotherapy (11% P < 0.01) and chemotherapy (10%, P < 0.001). Baseline hormone data were available for 367 patients. After treatment, compared to baseline, patients receiving chemotherapy had significantly greater elevations of FSH (median rise of 6 (IQR 3-9.25) iu l(-1) compared to 3 (IQR 1-5) iu l(-1) for S; P < 0.001) and a fall (compared to a rise in the surveillance group) in median testosterone levels (-2 (IQR -8.0 to -1.5) vs 1.0. (IQR -4.0-4.0) P < 0.001). Patients with low testosterone (but not elevated FSH) had lower quality of life scores related to sexual functioning on the testicular cancer specific module and lower physical, social and role functioning on the EORTC Qly C-30. Patients with a low testosterone also had higher body mass index and blood pressure. Treatment was associated with reduction in sexual activity and patients receiving chemotherapy had more concerns about fathering children. In total, 207 (30%) patients reported attempting conception of whom 159 (77%) were successful and a further 10 patients were successful after infertility treatment with an overall success rate of 82%. There was a lower overall success rate after chemotherapy (C 71%; CRT 67% compared to S 85% (P = 0.028)). Elevated FSH levels were associated with reduced fertility (normal FSH 91% vs elevated 68% P < 0.001). In summary, gonadal dysfunction is common in patients with a history of testicular cancer even when managed by orchidectomy alone. Treatment with chemotherapy in particular can result in additional impairment. Gonadal dysfunction reduces quality of life and has an adverse effect on patient health. Most patients retain their fertility, but the risk of infertility is likely to be increased by chemotherapy. Screening for gonadal dysfunction should be considered in the follow-up of testicular cancer survivors.

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Effect of treatment level on sexual quality of life. Mean scores represent the average score for the question. Each question is scored on a 4-point scale from 1 (none) to 4 (very much). Results statistically significant different (P⩽0.05) from surveillance are indicated by *.
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fig1: Effect of treatment level on sexual quality of life. Mean scores represent the average score for the question. Each question is scored on a 4-point scale from 1 (none) to 4 (very much). Results statistically significant different (P⩽0.05) from surveillance are indicated by *.

Mentions: We have investigated the long-term effects of treatment on sexuality by using the testicular module of the EORTC Qly C 30. This consists of six questions directed at sexual function and sexual satisfaction and two additional questions about effects on masculinity and concerns about fathering children. The results of these questions have been analysed by comparing the overall scores of patient groups and by the number of patients reporting significant effect (‘quite a bit' or ‘very much'). A proportion of patients (between 60 and 165 of 680 patients) did not answer these questions with no significant bias by treatment group. Overall sexual function seemed to be satisfactory with 83% of patients expressing satisfaction in their sexual relationships with their partner with no differences between treatment groups (Figure 1). Compared to surveillance there was a tendency for treated groups to have less sexual activity and less interest in sex. This was only statistically significant for CRT and less interest in sex (P=0.01) and borderline significant for CRT and RT and less sexual activity (both P=0.051). Additionally, radiotherapy treatment was associated with reduced sexual enjoyment (RT vs S P=0.05). Compared to surveillance patients, patients treated by chemotherapy had more worries about fathering children (P=0.009).


Fertility, gonadal and sexual function in survivors of testicular cancer.

Huddart RA, Norman A, Moynihan C, Horwich A, Parker C, Nicholls E, Dearnaley DP - Br. J. Cancer (2005)

Effect of treatment level on sexual quality of life. Mean scores represent the average score for the question. Each question is scored on a 4-point scale from 1 (none) to 4 (very much). Results statistically significant different (P⩽0.05) from surveillance are indicated by *.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2361550&req=5

fig1: Effect of treatment level on sexual quality of life. Mean scores represent the average score for the question. Each question is scored on a 4-point scale from 1 (none) to 4 (very much). Results statistically significant different (P⩽0.05) from surveillance are indicated by *.
Mentions: We have investigated the long-term effects of treatment on sexuality by using the testicular module of the EORTC Qly C 30. This consists of six questions directed at sexual function and sexual satisfaction and two additional questions about effects on masculinity and concerns about fathering children. The results of these questions have been analysed by comparing the overall scores of patient groups and by the number of patients reporting significant effect (‘quite a bit' or ‘very much'). A proportion of patients (between 60 and 165 of 680 patients) did not answer these questions with no significant bias by treatment group. Overall sexual function seemed to be satisfactory with 83% of patients expressing satisfaction in their sexual relationships with their partner with no differences between treatment groups (Figure 1). Compared to surveillance there was a tendency for treated groups to have less sexual activity and less interest in sex. This was only statistically significant for CRT and less interest in sex (P=0.01) and borderline significant for CRT and RT and less sexual activity (both P=0.051). Additionally, radiotherapy treatment was associated with reduced sexual enjoyment (RT vs S P=0.05). Compared to surveillance patients, patients treated by chemotherapy had more worries about fathering children (P=0.009).

Bottom Line: After treatment, compared to baseline, patients receiving chemotherapy had significantly greater elevations of FSH (median rise of 6 (IQR 3-9.25) iu l(-1) compared to 3 (IQR 1-5) iu l(-1) for S; P < 0.001) and a fall (compared to a rise in the surveillance group) in median testosterone levels (-2 (IQR -8.0 to -1.5) vs 1.0. (IQR -4.0-4.0) P < 0.001).Treatment was associated with reduction in sexual activity and patients receiving chemotherapy had more concerns about fathering children.Gonadal dysfunction reduces quality of life and has an adverse effect on patient health.

View Article: PubMed Central - PubMed

Affiliation: Academic Unit of Radiotherapy and Oncology, Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey SM2 5PT, UK. Robert.Huddart@icr.ac.uk

ABSTRACT
Modern treatments cure most testicular cancer patients, so an important goal is to minimise toxicity. Fertility and sexual functioning are key issues for patients. We have evaluated these outcomes in a cross-sectional study of long-term survivors of testicular cancer. In total, 680 patients treated between 1982 and 1992 completed the EORTC Qly-C-30(qc30) questionnaire, the associated testicular cancer specific module and a general health and fertility questionnaire. Patients have been subdivided according to treatment received: orchidectomy either alone (surveillance, S n = 169), with chemotherapy (C, n = 272), radiotherapy (R, n = 158), or both chemotherapy and radiotherapy (C/RT n = 81). In the surveillance group, 6% of patients had an elevated LH, 41% an elevated FSH and 11% a low (< 10 nmol l(-1)) testosterone. Hormonal function deteriorated with additional treatment, but the effect in general was small. Low testosterone was more common in the C/RT group (37% P = 0.006), FSH abnormalities were more common after chemotherapy (C 49%, C/RT 71% both P < 0.005) and LH abnormalities after radiotherapy (11% P < 0.01) and chemotherapy (10%, P < 0.001). Baseline hormone data were available for 367 patients. After treatment, compared to baseline, patients receiving chemotherapy had significantly greater elevations of FSH (median rise of 6 (IQR 3-9.25) iu l(-1) compared to 3 (IQR 1-5) iu l(-1) for S; P < 0.001) and a fall (compared to a rise in the surveillance group) in median testosterone levels (-2 (IQR -8.0 to -1.5) vs 1.0. (IQR -4.0-4.0) P < 0.001). Patients with low testosterone (but not elevated FSH) had lower quality of life scores related to sexual functioning on the testicular cancer specific module and lower physical, social and role functioning on the EORTC Qly C-30. Patients with a low testosterone also had higher body mass index and blood pressure. Treatment was associated with reduction in sexual activity and patients receiving chemotherapy had more concerns about fathering children. In total, 207 (30%) patients reported attempting conception of whom 159 (77%) were successful and a further 10 patients were successful after infertility treatment with an overall success rate of 82%. There was a lower overall success rate after chemotherapy (C 71%; CRT 67% compared to S 85% (P = 0.028)). Elevated FSH levels were associated with reduced fertility (normal FSH 91% vs elevated 68% P < 0.001). In summary, gonadal dysfunction is common in patients with a history of testicular cancer even when managed by orchidectomy alone. Treatment with chemotherapy in particular can result in additional impairment. Gonadal dysfunction reduces quality of life and has an adverse effect on patient health. Most patients retain their fertility, but the risk of infertility is likely to be increased by chemotherapy. Screening for gonadal dysfunction should be considered in the follow-up of testicular cancer survivors.

Show MeSH
Related in: MedlinePlus