Chronic fatigue a long-term problem for testicular cancer survivors

By Shreeya Nanda, Senior medwireNews Reporter

A Norwegian population-based study reported in the Annals of Oncology has found a rise in the incidence of chronic fatigue a decade or more after treatment in testicular cancer survivors.

The researchers recommend that healthcare professionals should keep in mind the “early prevention of [chronic fatigue] through life style interventions and early detection, and treatment and follow-up of comorbid conditions” during the management of not only testicular cancer survivors but also those who have survived other cancers.

Of 1814 men who received treatment for unilateral germ cell testicular cancer between 1980 and 1994, around 80% participated in two national surveys conducted between 1998 and 2002 and between 2007 and 2008. Blood specimens and complete questionnaires at both surveys were available for 812 men who formed the sample analysed by Jan Oldenburg, from Oslo University Hospital, and co-workers in this study.

As assessed by the Fatigue Questionnaire, chronic fatigue was reported by 15% of participants in the first survey and by 27% in the second survey, at a median of 12 years and 19 years post-treatment, respectively. Approximately two-thirds of men had chronic fatigue at both surveys.

Multivariate analysis using data from the second survey showed that higher levels of anxiety and depression, as measured by the Hospital Anxiety and Depression Scale, significantly increased the risk of chronic fatigue compared with lower levels,with odds ratios (ORs) of 2.53 and 5.41, respectively.

In addition, men reporting to be affected very much or quite a bit by neuropathy (ORs=3.43 and 3.08, respectively) and very much affected by Raynaud’s phenomenon (OR=2.37) had greater risk of developing chronic fatigue compared with men without neuropathy and Raynaud’s phenomenon, respectively.

And the risk was also significantly higher for testicular cancer survivors with testosterone levels in the lowest and second highest quartiles than for those with testosterone levels in the highest quartile, with ORs of 3.20 and 2.63, respectively.

By contrast, men who were moderately or highly physically active significantly reduced their risk of developing chronic fatigue with ORs of 0.47 and 0.31, respectively, compared with men who reported being inactive.

Oldenburg et al note that fewer factors correlated significantly with chronic fatigue risk at the first survey – the only ones with a significant association being higher versus lower levels of anxiety and depression, reporting the highest level of neuropathy and the second highest level of ototoxicity compared with lack of these toxicities. And they wonder whether “[t]he increase in factors associated with [chronic fatigue] accompanying an increase in the prevalence of fatigue might represent a shared development”.

They conclude: “[Chronic fatigue] may dramatically impair quality of life, and its disturbing increase in [testicular cancer survivors] and the association with partly treatable side effects, underlines the importance of continued long-term assessments of cancer survivors.”

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