Relationship of Cisplatin-Related Adverse Health Outcomes with Disability and Unemployment Among Testicular Cancer Survivors
Menée aux Etats-Unis à partir de données portant sur 1 815 patients ayant survécu 1 an ou plus à un cancer du testicule, cette étude analyse l’association entre la survenue d’événements indésirables induits par une chimiothérapie à base de cisplatine (neuropathie périphérique, perte auditive, acouphènes, maladie rénale, etc.), des caractéristiques sociodémographiques et ethniques et la situation professionnelle (chômage)
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 : 1,815 TCS ?1 year post-chemotherapy underwent clinical examination and completed questionnaires. Treatment data were abstracted from medical records. A cumulative burden of morbidity score (CBMPt) encompassed the number/severity of platinum-related AHOs (peripheral sensory neuropathy (PSN), hearing loss, tinnitus, renal disease). Multivariable regression assessed association of AHOs/CBMPt with employment status and SRH, adjusting for sociodemographic/clinical characteristics. Unemployment was compared with a male, normative population of similar age/race/ethnicity. Results : Almost 1 in 10 TCS were out of work (2.4%-disability leave, 6.8%-unemployed) at a median age of 37yr (median follow-up: 4yr). PSN (OR?=?2.89; 95% CI 1.01-8.26: grade 3 vs. 0, P?=?0.048), renal dysfunction defined by estimated glomerular filtration rate (OR?=?12.1; 95% CI 2.06-70.8: grade 2 vs. 0, P?=?0.01), pain (OR?=?10.6; 95% CI 4.40-25.40: grade 2/3 vs. 0, P?<?0.001), and CBMPt (OR?=?1.46, 95% CI 1.03-2.08; P?=?0.03) were associated with disability leave; pain strongly correlated with PSN (r2=0.40; P?<?0.001). Statistically significantly higher percentages of TCS were unemployed vs. population norms (age-adjusted OR?=?2.67, 95% CI 2.49-3.02; P?<?0.001). PSN (OR?=?2.44; 95% CI 1.28-4.62: grade 3 vs. 0, P?=?0.006), patient-reported-hearing-loss (OR?=?1.82; 95% CI 1.04-3.17: grade 2/3 vs. 0, P?=?0.04), and pain (OR?=?3.75; 95% CI 2.06-6.81: grade 2/3 vs. 0, P?<?0.001) 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/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.
JNCI Cancer Spectrum 2020