Testicular Cancer Survivors Need Adequate Screening for Long Term Heart Disease Risks

In In The News by Barbara Jacoby

Largest study to date addressing the prevalence of metabolic abnormalities in testicular cancer survivors who received prior chemotherapy publishes findings in the latest issue of JNCCN

Testicular cancer is the most common cancer in young men and the great majority of patients are cured of their disease[1], but a newly-published study shows many remain at risk for later complications from chemotherapy or other treatments. The study in JNCCN –Journal of the National Comprehensive Cancer Network confirms that testicular cancer survivors (TCS) are more likely to develop high blood pressure, high cholesterol, and obesity, which can significantly increase their risk of heart disease. The Platinum Study, which was funded by the National Cancer Institute, is the largest study to examine the rates of metabolic abnormalities among testicular cancer survivors who received prior platinum-based chemotherapy, and the only study using North American patients, rather than European.

“The North American population is generally more ethnically and genetically diverse compared to Europeans, making it interesting to examine the similarities and differences in potential genetic risk factors for metabolic syndrome (MetS),” said Mohammad Abu Zaid, MD, Assistant Professor of Medicine, Indiana University School of Medicine and Indiana University Melvin and Bren Simon Cancer Center. For the study, MetS was defined by the standard medical criteria of three or more of the following conditions: hypertension, abdominal obesity, hypertriglyceridemia (elevated triglyceride levels), decreased levels of high-density lipoprotein (HDL, often referred to as “good cholesterol”), and diabetes. “We found that one in ten testicular cancer survivors under age 30 had metabolic syndrome, and that increased to more than a third of patients over age 50. However, some of the genetic changes that reportedly play a large role in increasing the risk of MetS among Europeans were not factors for our patients.”

The researchers evaluated 486 testicular cancer survivors, with a median age of 38.1 years, and found they were more likely to have hypertension than their cancer-free peers, (43.2% vs. 30.7%, P<.001), but were less likely to have lower levels of “good cholesterol” (23.7% vs. 34.8%, P<.001), or abdominal obesity (28.2% vs. 40.1%, P<.001). As for other potential heart disease risk factors, testicular cancer survivors were significantly more likely to have higher amounts of low-density lipoprotein (LDL, commonly referred to as “bad cholesterol”) (17.7% vs. 9.3%, P<.001), higher overall cholesterol levels (26.3% vs 11.1%, P<.001), and be classified as overweight based on their body mass index (75.1% vs. 69.1%, P=.04).

“For testicular cancer survivors, as with most cancer survivors, the medical concerns don’t end with remission,” explained Timothy Gilligan, MD, MS, Vice Chair for Education & Associate Professor of Medicine, Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute. Dr. Gilligan Chairs the NCCN Guidelines Panel on Testicular Cancer. “Testicular cancer survivors whose treatment included chemotherapy, radiation therapy, or both have an increased risk of dying from cardiovascular disease. This study provides valuable information as we try to understand why. It also serves as an important reminder for appropriate long-term healthcare after completing cancer treatment, as detailed in the NCCN Guidelines for Survivorship.”

“The overarching goal of our study is to implement early interventions in order to reduce the risk of heart disease,” said Dr. Abu Zaid. “At this time, there are no criteria for determining what exactly causes metabolic syndrome in cancer survivors. Developing those criteria requires long-term follow up of cancer survivors, which is something we’ll be doing as part of this ongoing Platinum Study. This will help us understand which risk factors are more likely to lead to heart disease for this particular population.”

The researchers encourage providers to screen and adequately treat testicular cancer survivors for hypertension, dyslipidemia, and hypogonadism, and to advocate for the adoption of healthy lifestyle practices like regular exercise and tobacco avoidance. They also recommend that young testicular cancer survivors discuss the risks and benefits of testosterone replacement therapy with their physicians. Testicular cancer survivors with abnormally low testosterone levels may experience fatigue, low energy, and decreased sexual desire. In addition they can be at risk for metabolic syndrome, decreased muscle mass, fragile bones (osteoporosis), and potentially heart disease.

Complimentary access to the study, “Clinical and Genetic Risk Factors for Adverse Metabolic Outcomes in North American Testicular Cancer Survivors” is available until April 11, 2018 at JNCCN.org.

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About JNCCN—Journal of the National Comprehensive Cancer Network
More than 25,000 oncologists and other cancer care professionals across the United States read JNCCN—Journal of the National Comprehensive Cancer Network. This peer-reviewed, indexed medical journal provides the latest information about best clinical practices, health services research, and translational medicine. JNCCN features updates on the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®), review articles elaborating on guidelines recommendations, health services research, and case reports highlighting molecular insights in patient care. JNCCN is published by Harborside Press. Visit JNCCN.org. To inquire if you are eligible for a FREE subscription to JNCCN, visit http://www.nccn.org/jnccn/subscribe.asp. Follow JNCCN on Twitter @JNCCN.

About the National Comprehensive Cancer Network

The National Comprehensive Cancer Network® (NCCN®), a not-for-profit alliance of 27 leading cancer centers devoted to patient care, research, and education, is dedicated to improving the quality, effectiveness, and efficiency of cancer care so that patients can live better lives. Through the leadership and expertise of clinical professionals at NCCN Member Institutions, NCCN develops resources that present valuable information to the numerous stakeholders in the health care delivery system. As the arbiter of high-quality cancer care, NCCN promotes the importance of continuous quality improvement and recognizes the significance of creating clinical practice guidelines appropriate for use by patients, clinicians, and other health care decision-makers.

The NCCN Member Institutions are: Fred & Pamela Buffett Cancer Center, Omaha, NE; Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; City of Hope Comprehensive Cancer Center, Los Angeles, CA; Dana-Farber/Brigham and Women’s Cancer Center | Massachusetts General Hospital Cancer Center, Boston, MA; Duke Cancer Institute, Durham, NC; Fox Chase Cancer Center, Philadelphia, PA; Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT; Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance, Seattle, WA; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL; Mayo Clinic Cancer Center, Phoenix/Scottsdale, AZ, Jacksonville, FL, and Rochester, MN; Memorial Sloan Kettering Cancer Center, New York, NY; Moffitt Cancer Center, Tampa, FL; The Ohio State University Comprehensive Cancer Center – James Cancer Hospital and Solove Research Institute, Columbus, OH; Roswell Park Comprehensive Cancer Center, Buffalo, NY; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, MO; St. Jude Children’s Research Hospital/The University of Tennessee Health Science Center, Memphis, TN; Stanford Cancer Institute, Stanford, CA; University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, AL; UC San Diego Moores Cancer Center, La Jolla, CA; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; University of Colorado Cancer Center, Aurora, CO; University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; The University of Texas MD Anderson Cancer Center, Houston, TX; University of Wisconsin Carbone Cancer Center, Madison, WI; Vanderbilt-Ingram Cancer Center, Nashville, TN; and Yale Cancer Center/Smilow Cancer Hospital, New Haven, CT.