Relationship of Cisplatin-Related Adverse Health Outcomes With Disability and Unemployment Among Testicular Cancer Survivors

Sarah L Kerns; Chunkit Fung; Sophie D Fossa; Paul C Dinh Jr; Patrick Monahan; Howard D Sesso; Robert D Frisina; Darren R Feldman; Robert J Hamilton; David Vaughn; Neil Martin; Robert Huddart; Christian Kollmannsberger; Deepak Sahasrabudhe; Shirin Ardeshir-Rouhani-Fard; Lawrence Einhorn; Lois B Travis

doi:10.1093/jncics/pkaa022

Relationship of Cisplatin-Related Adverse Health Outcomes With Disability and Unemployment Among Testicular Cancer Survivors

JNCI Cancer Spectr. 2020 Mar 20;4(4):pkaa022. doi: 10.1093/jncics/pkaa022. eCollection 2020 Aug.

Authors

Sarah L Kerns¹, Chunkit Fung¹, Sophie D Fossa², Paul C Dinh Jr³, Patrick Monahan³, Howard D Sesso⁴, Robert D Frisina⁵, Darren R Feldman⁶, Robert J Hamilton⁷, David Vaughn⁸, Neil Martin⁹, Robert Huddart¹⁰, Christian Kollmannsberger¹¹, Deepak Sahasrabudhe¹, Shirin Ardeshir-Rouhani-Fard³, Lawrence Einhorn³, Lois B Travis³

Affiliations

¹ University of Rochester Medical Center, Rochester, NY, USA.
² Oslo University Hospital, Oslo, Norway.
³ Indiana University, Indianapolis, IN, USA.
⁴ Brigham and Women's Hospital, Boston, MA, USA.
⁵ University of South Florida, Tampa, FL, USA.
⁶ Memorial Sloan Kettering Cancer Center, New York, NY, USA.
⁷ Princess Margaret Cancer Center, Toronto, Canada.
⁸ University of Pennsylvania, Philadelphia, PA, USA.
⁹ Dana-Farber Cancer Institute, Boston, MA, USA.
¹⁰ Royal Marsden Hospital, London, UK.
¹¹ University of British Columbia, Vancouver, British Columbia, Canada.

Abstract

Background: Few data exist on the relationship of cisplatin-related adverse health outcomes (AHOs) with disability, unemployment, and self-reported health (SRH) among testicular cancer survivors (TCS).

Methods: A total of 1815 TCS at least 1 year postchemotherapy underwent clinical examination and completed questionnaires. Treatment data were abstracted from medical records. A cumulative burden of morbidity score (CBM_Pt) encompassed the number and severity of platinum-related AHOs (peripheral sensory neuropathy [PSN], hearing loss, tinnitus, renal disease). Multivariable regression assessed the association of AHOs and CBM_Pt with employment status and SRH, adjusting for sociodemographic and clinical characteristics. Unemployment was compared with a male normative population of similar age, race, and ethnicity.

Results: Almost 1 in 10 TCS was out of work (2.4%, disability leave; 6.8%, unemployed) at a median age of 37 years (median follow-up = 4 years). PSN (odds ratio [OR] = 2.89, 95% confidence interval [CI] = 1.01 to 8.26, grade 3 vs 0, P = .048), renal dysfunction defined by estimated glomerular filtration rate (OR = 12.1, 95% CI = 2.06 to 70.8, grade 2 vs 0, P = .01), pain (OR = 10.6, 95% CI = 4.40 to 25.40, grade 2 or 3 vs 0, P < .001), and CBM_Pt (OR = 1.46, 95% CI = 1.03 to 2.08, P = .03) were associated with disability leave; pain strongly correlated with PSN (r ² = 0.40, P < .001). Statistically significantly higher percentages of TCS were unemployed vs population norms (age-adjusted OR = 2.67, 95% CI = 2.49 to 3.02, P < .001). PSN (OR = 2.44, 95% CI = 1.28 to 4.62, grade 3 vs 0, P = .006), patient-reported hearing loss (OR = 1.82, 95% CI = 1.04 to 3.17, grade 2 or 3 vs 0, P = .04), and pain (OR = 3.75, 95% CI = 2.06 to 6.81, grade 2 or 3 vs 0, P < .001) were associated with unemployment. Increasing severity of most cisplatin-related AHOs and pain were associated with statistically significantly worse SRH.

Conclusions: Our findings have important implications regarding treatment-associated productivity losses and socioeconomic costs in this young population. Survivorship care strategies should include inquiries about disability and unemployment status, with efforts made to assist affected TCS in returning to the workforce.

Abstract

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