The effects of hypogonadism on quality of life in survivors of germ cell tumors treated with surgery alone versus surgery plus platinum-based chemotherapy

• Published in: Supportive care in cancer Vol. 28; no. 7; pp. 3165 - 3170
• Main Authors: Khanal, N., Ahmed, S. S., Kalra, M., Miller, T. J., Brames, M. J., Stump, T. E., Monahan, P., Hanna, N. H., Einhorn, Lawrence H.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-07-2020; Springer Nature B.V
• Subjects: Cancer surgery; Chemotherapy; Clinical outcomes; Medicine; Medicine & Public Health; Nursing; Nursing Research; Oncology; Original Article; Pain Medicine; Palliative care; Quality of life; Rehabilitation Medicine; Survivor; Testosterone; Tumors; Testosterone replacement; Platinum-based chemotherapy; Germ cell tumor survivorship; Hypogonadism; Quality of life
• ISSN: 0941-4355; 1433-7339
• DOI: 10.1007/s00520-019-05117-0

Background
It is important to assess the prevalence of hypogonadism and to identify the correlation between hypogonadism and cancer treatment with quality of life (QoL) in germ cell tumor (GCT) survivors.
Methods
This is a single-center, non-randomized, prospective observational study in GCT survivors 18–50 years of age previously treated with surgery and chemotherapy (S+C) or surgery alone (S). Patients completed a validated QoL questionnaire at baseline, 3, and 6 months. Patients received supplemental testosterone as clinically indicated. Mean QoL scores were compared between two treatment groups (S+C vs. S) and within each group between survivors with hypogonadism (serum testosterone level < 300 ng/dL) versus without. A two-sided independent-groups
t
test was used to compare means.
Results
We evaluated 199 GCT survivors. At baseline, the prevalence of biochemical hypogonadism was 48% overall, 51% in S+C group, and 45% in S group (
p
 = .4). Overall, there was no statistically significant difference in QoL scores between S+C and C groups, except the S+C group exhibited greater modified Aging Male Symptoms (AMS) at baseline and 6 months. Patients with hypogonadism reported more fatigue, poor sleep quality, and worse general health at baseline. There were no statistical differences in mean QOL scores between patients with testosterone < 300 ng/dL who received testosterone supplementation and who did not.
Conclusion
A significant proportion of GCT survivors have low testosterone levels after platinum-based chemotherapy and surgery as well as with just surgery alone. GCT survivors treated with platinum-based chemotherapy exhibited more symptoms related to male aging compared with survivors treated with surgery alone.