Predicted cardiovascular mortality and reported cardiovascular morbidity in testicular cancer survivors

• Published in: Journal of cancer survivorship 2008-09, Vol.2 (3), p.128-137
• Main Authors: Haugnes, H. S., Aass, N., Fosså, S. D., Dahl, O., Klepp, O., Wist, E. A., Wilsgaard, T., Bremnes, R. M.
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Antineoplastic Combined Chemotherapy Protocols - adverse effects; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Carcinoma - epidemiology; Carcinoma - therapy; Cardiovascular disease; Cardiovascular Diseases - diagnosis; Cardiovascular Diseases - epidemiology; Cardiovascular Diseases - mortality; Chemotherapy; Cisplatin - administration & dosage; Cisplatin - adverse effects; Cohort Studies; Comorbidity; Cross-Sectional Studies; Follow-Up Studies; Health Informatics; Health Promotion and Disease Prevention; Humans; Male; Medicine; Medicine & Public Health; Middle Aged; Morbidity; Mortality; Oncology; Primary Care Medicine; Prognosis; Public Health; Quality of Life Research; Research Design; Risk Assessment; Risk factors; Seminoma - epidemiology; Seminoma - therapy; Survivor; Survivors - statistics & numerical data; Testicular cancer; Testicular Neoplasms - epidemiology; Testicular Neoplasms - therapy; Young Adult
• ISSN: 1932-2259; 1932-2267
• DOI: 10.1007/s11764-008-0054-1

Introduction We examined if testicular cancer (TC) treatment is associated with any risk for cardiovascular morbidity or predicted mortality according to the SCORE model, in which a 10-year future risk of ≥5% for developing a fatal cardiovascular event qualify for high-risk status. Methods One thousand one hundred thirty-four TC survivors treated 1980–1994 participated in this study (1998–2002). Patients were categorised in four treatment groups: surgery ( n  = 225), radiotherapy ( n  = 445), and two chemotherapy groups: cumulative cisplatin dose ≤850 mg ( n  = 375) and >850 mg (cis>850, n  = 89). Patients with cardiovascular disease, diabetes or SCORE ≥5% constituted a high-risk group, and those with SCORE >1% an intermediate/high risk group. Results Age-adjusted mean SCORE was 0.93% for the surgery group. In comparison, chemotherapy treated patients had significantly higher SCORE (1.07%, p  = 0.01). Only 15% of patients were scored to be at high-risk, while 53% qualified for the intermediate/high risk group. Patients in the cis>850 group had increased odds for having intermediate/high risk, compared with the surgery group (OR 3.4, 95% CI 1.3–8.7). Only 23 cardiovascular events had occurred since the testicular cancer diagnosis. Conclusion The SCORE model indicates that patients treated with cisplatin-based chemotherapy have a significantly increased future risk of a fatal cardiovascular event. Implications for cancer survivors TC survivors should be followed regularly with respect to cardiovascular risk profile beyond the routine 10-year clinical follow-up.