To evaluate whether selected modifiable patient-reported adverse health outcomes (AHOs) in testicular cancer survivors (TCSs) represent prognostic factors of overall mortality, cancer mortality, and first-time non–germ cell second cancer (SecCa) incidence.

In 775 long-term TCSs (diagnosis: 1980-1994) who previously participated in a quality-of-life survey, 20-year mortality and SecCa incidence were compared between the surgery group (n = 272) and TCSs after platinum-based chemotherapy (PBCT; n = 503). A PBCT standard group (total cisplatin: ≤ 630 mg: n = 124) was separated from a PBCT high subgroup (total cisplatin: > 630 mg; n = 379). Univariate and multivariate analyses (Kaplan-Meier; Cox proportional hazard analyses) included age, treatment, and prior major physical comorbidity as nonmodifiable factors, whereas low socioeconomic status, unhealthy lifestyle, probable depression disorder, and neurotoxicity were modifiable AHOs.

For all TCSs, the cumulative overall 20-year mortality was 14% (95% CI, 11.8 to 16.8). Rising age, PBCT high, and comorbidity significantly increased the risk of overall mortality rate. Compared with a low-risk group (no AHO; n = 446) and with exception of neurotoxicity, this risk was further significantly enhanced by 80% in TCSs of a medium-risk group (one or two AHOs; n = 278). In men of a high-risk group (three AHOs; n = 47), the probability of overall mortality and of cancer mortality was eight-fold and five-fold increased, respectively. Risk grouping did not influence on SecCa incidence.

Self-reported unfavorable modifiable AHO concerning lifestyle and psychosocial health are in TCSs independently and significantly associated with increased overall mortality and cancer mortality. Health professionals and the TCSs themselves, particularly those after PBCT high, should continuously be aware of these risk factors attempting maximal reduction of these AHOs and thereby supporting long-term survival.

© 2022 by American Society of Clinical Oncology

  • Key Objective

  • We evaluated whether modifiable adverse health outcomes (AHOs) such as low socioeconomics, an unhealthy lifestyle, or probable depressive disorder increase long-term testicular cancer survivors' (TCSs) risk of second cancer and overall and cancer mortality.

  • Knowledge Generated

  • Compared with TCSs not reporting any of the above three AHOs, the risk of 20-year overall mortality was almost doubled in TCSs with one or two AHOs, and was eight-fold increased in those reporting all three AHOs. In Cox analyses of additional factors, depressive disorder, age, and ≥ 4 cycles of platinum-based chemotherapy were significantly associated with worse overall and cancer mortality.

  • Relevance

  • In long-term TCSs, the above modifiable AHOs represent independent risk factors of premature death. Health professionals and the TCSs themselves should aim efforts at improving socioeconomics and supporting a healthy lifestyle. Evaluating and treating depression may also improve outcomes.


Supported by the Radium Hospital Foundation Grant no. 335007.

Conception and design: Sophie D. Fosså, Lene Thorsen, Cecilie E. Kiserud, Hege S. Haugnes, Tor Å. Myklebust

Financial support: Sophie D. Fosså

Administrative support: Sophie D. Fosså, Cecilie E. Kiserud

Provision of study materials or patients: Sophie D. Fosså, Torgrim Tandstad, Marianne Brydøy, Hege S. Haugnes

Collection and assembly of data: Sophie D. Fosså, Torgrim Tandstad, Marianne Brydøy, Hege S. Haugnes, Tor Å. Myklebust

Data analysis and interpretation: Sophie D. Fosså, Alv A. Dahl, Lene Thorsen, Ragnhild Hellesnes, Cecilie E. Kiserud, Hege S. Haugnes, Tor Å. Myklebust

Manuscript writing: All authors

Final approval of manuscript: All authors

Accountable for all aspects of the work: All authors

Mortality and Second Cancer Incidence After Treatment for Testicular Cancer: Psychosocial Health and Lifestyle Are Modifiable Prognostic Factors

The following represents disclosure information provided by authors of this manuscript. All relationships are considered compensated unless otherwise noted. Relationships are self-held unless noted. I = Immediate Family Member, Inst = My Institution. Relationships may not relate to the subject matter of this manuscript. For more information about ASCO's conflict of interest policy, please refer to or

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No potential conflicts of interest were reported.

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DOI: 10.1200/JCO.21.02105 Journal of Clinical Oncology 40, no. 23 (August 10, 2022) 2588-2599.

Published online April 05, 2022.

PMID: 35380874

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