CHICAGO — Despite being at risk of cardiovascular problems associated with testicular cancer treatment, survivors of the disease -- the most common type of cancer striking young men -- frequently report behaviors such as smoking and risky alcohol use that could further raise their chances of developing those late effects of treatment, according to a study from the Perelman School of Medicine at the University of Pennsylvania that will be presented at the annual meeting of American Society of Clinical Oncology meeting on Saturday, June 2.
Long-term studies have shown that testicular cancer survivors who received radiation and chemotherapy have an increased risk of cardiovascular problems and death compared to the general population, and that chemotherapy for the disease may also pose a higher risk of developing metabolic syndromes. Patients may reduce their chances of developing of these problems by adopting healthy diet and exercise habits, refraining from smoking, and limiting alcohol consumption, but the new study shows that many testicular cancer survivors are, instead, placing themselves at even greater risk.
The team studied 189 patients who were diagnosed with testicular cancer between 1990 and 2007 and recruited through the Pennsylvania Cancer Registry. Patients, who were, on average, 44 years old and 6.8 years post-diagnosis, completed surveys about various health habits. Almost 25 percent of patients surveyed reported current tobacco use, and 35 percent reported "risky" alcohol use, which the researchers defined as 14 or more drinks per week, four or more drinks during drinking days, or 5 or more drinks at a sitting at least twice over the past year. Half of patients reported participating in adequate aerobic exercise, but only 28 percent reported sufficient strength and flexibility activities. Unhealthy weight was the most commonly reported risk factor for cardiovascular problems, with 85 percent of survivors reporting a BMI that would classify them as overweight, and 35 percent of patients falling into the obese range.
Among barriers to healthy behaviors that might play a role in cardiovascular risk reduction, respondents cited cancer-related physical problems including neuropathy, pain, or hernia risk, and competing demands such as work or time constraints. Those who noted cancer-related barriers were shown to have a worse physical quality of life overall, and a higher BMI. Those who cited competing demands for their time appeared to have worse psychosocial quality of life and to report unhealthy eating habits and insufficient exercise.
The researchers suggest the findings could guide the creation of interventions aimed at reducing tobacco and risky alcohol use, as well as education and strategies to help patients improve their diets and boost their physical activity levels. Ideas to help patients adopt more healthy behaviors as they transition to life as cancer survivors might include such things as integrating "wellness" programs more explicitly into survivorship care, and providing patients with survivorship care plans that explain the potential long-term effects of cancer and its treatment and what can be done to minimize these effects.
"There has been fantastic progress made in treating testicular cancer," says Steven C. Palmer, PhD, a research assistant professor of Clinical Psychology in Psychiatry who serves as research director in the LiveSTRONG Living Well After Cancer program in Penn's Abramson Cancer Center. "Now there needs to be as much effort put into understanding how to support the healthy behaviors that will allow these men to reduce their risk of future health problems and improve both the quantity and the quality of their lives."
The study was funded by the National Cancer Institute (R03 CA124217-02) and the LIVESTRONG Foundation.
Editors Note: Linda Jacobs, PhD, RN, a co-author of the study and director of the Abramson Cancer Center's LIVESTRONG Survivorship Center of Excellence, will present the study findings (Abstract # 9145) in the Patient and Survivor Care poster session on Saturday, June 2 between 8 a.m. and noon in S Hall A2 of McCormick Place in Chicago.