Cumulative burden of morbidity (CBM) among testicular cancer survivors (TCS) in the Platinum study.

Late- and Long-term Effects/Comorbidities
Session Type and Session Title: 
Poster Session A
General Session 1: Risk-Based Health Care of Cancer Survivors in the 21st Century
Abstract Number: 


Poster Board Number: 
Poster Session A Board #A2
J Clin Oncol 34, 2016 (suppl 3S; abstr 106)
Sarah L Kerns, Chunkit Fung, AnnaLynn Williams, Mohammad Issam Abu Zaid, Howard D. Sesso, Darren R. Feldman, Robert James Hamilton, David J. Vaughn, Clair Beard, Hai Liu, David Herrmann, Deepak M. Sahasrabudhe, Sophie D. Fossa, Lawrence H. Einhorn, Lois B. Travis, The Platinum Study Group; University of Rochester Medical Center, Rochester, NY; Wilmot Cancer Center, Rochester, NY; University of Rochester School of Medicine and Dentistry, Rochester, NY; Indiana University School of Medicine, Indianapolis, IN; Division of Preventive Medicine, Harvard Medical School, Boston, MA; Memorial Sloan Kettering Cancer Center, New York, NY; Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada; Abramson Cancer Center of the University of Pennsylvania, Philadelphia, PA; Dana-Farber Cancer Institute, Brigham and Women's Hospital, Boston, MA; Oslo University Hospital, University of Oslo, Oslo, Norway; Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN

Abstract Disclosures


Background: Few studies have systematically evaluated CBM in survivors of adult-onset cancer, accounting for both the number and severity of health conditions (HCs). TCS provide a unique opportunity to do this, given their young age at diagnosis, relatively homogeneous cisplatin-based chemotherapy (CHEM) and high cure rates. We comprehensively evaluated CBM after CHEM among TCS enrolled in an ongoing multi-center investigation (the Platinum Study). Methods: Eligible TCS (aged < 50 y at diagnosis and given first line CHEM) completed questionnaires assessing a comprehensive panel of HCs and prescription drug use. HCs (n = 54) were mapped and graded to the NCI Common Terminology Criteria for Adverse Events v4.03. A CBM score was calculated based on number and severity of each HC, following Geenen et al. (JAMA 2007; 297:2705). To examine the association between CBM score and both health status and cumulative cisplatin dose, we applied ordinal logistic regression adjusting for age at evaluation and bleomycin use. Results: Among the first 751 consecutively enrolled TCS, median age at evaluation was 38 y and median time since CHEM 4.6 y (range, 1-30 y). The most common HCs were paresthesias (27% grade 1, 18% grade 2, 17% grade 3), hearing loss (27% grade 1, 15% grade 1, 1.3% grade 3, 0.1% grade 4), tinnitus (31% grade 1, 7% grade 2, 7% grade 3), and obesity (42% grade 2, 29% grade 3, 4% grade 4. Low, medium, high, and severe CBM scores were observed in 8%, 69%, 20%, and 0.5% TCS, respectively, with a score of zero in 3%. Increasing CBM score was significantly associated with worse self-reported health status (OR = 2.34, 95% CI 1.91, 2.87; p < 0.001). Each 100 mg/m2 increase in cisplatin dose was associated with a non-significant increase in CBM (OR per 100 mg/m2 = 1.14; 95% CI, 0.96-1.34; p = 0.129). Adjustment for bleomycin did not affect results. CBM score increased with older age at evaluation (p < 0.001). Conclusions: CBM is strongly correlated with worse self-reported health, indicating that HCs frequently seen after CHEM are perceived by TCS as impacting negatively on their health. Survivorship care plans for TCS should take into account the CBM which appears relatively early, and is likely to increase with the aging of this population.