Cognitive Impairment in Long-Term Survivors of Testicular Cancer More Than 20 Years after Treatment
Background: Impaired cognition can be a late effect after treatment in long-term testicular cancer (TC) survivors, negatively affecting their daily life. However, little data is available beyond 20 years post-treatment. We assessed cognitive impairment in very long-term TC survivors after CT or RT a...
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2021
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oai:doaj.org-article:16becf8f36a942829bc04930df6e0da42021-11-25T17:02:31ZCognitive Impairment in Long-Term Survivors of Testicular Cancer More Than 20 Years after Treatment10.3390/cancers132256752072-6694https://doaj.org/article/16becf8f36a942829bc04930df6e0da42021-11-01T00:00:00Zhttps://www.mdpi.com/2072-6694/13/22/5675https://doaj.org/toc/2072-6694Background: Impaired cognition can be a late effect after treatment in long-term testicular cancer (TC) survivors, negatively affecting their daily life. However, little data is available beyond 20 years post-treatment. We assessed cognitive impairment in very long-term TC survivors after CT or RT and compared the results with stage I TC survivors and controls. Methods: In this cross-sectional multicenter cohort study, we enrolled TC survivors (treated with orchiectomy followed by CT or RT or orchiectomy only)—with a follow-up duration ≥ 20 years—and age-matched healthy controls. Cognitive testing included the Auditory Verbal Learning Test, Letter Fluency Test, Category Fluency Test, and Trail Making Test. We used fasting blood samples to assess the presence of hypogonadism and measured cardiovascular aging parameters, including carotid pulse wave velocity (c-PWV) and advanced glycation end products (AGEs). Results: We included 184 TC survivors (66 CT patients, 53 RT patients, and 65 orchiectomy-only patients) and 70 healthy controls. The median follow-up was 26 years (range: 20–42). TC survivors had a lower combined score of the cognitive tests (mean cumulative Z-score −0.85; 95% CI −1.39 to −0.33) compared to controls (mean 0.67; 95% CI −0.21 to 1.57, <i>p</i> < 0.01). In univariate analysis, the presence of hypogonadism (β −1.50, <i>p</i> < 0.01), high c-PWV (β −0.35, <i>p</i> = 0.09), and high AGEs (β −1.27, <i>p</i> = 0.02) were associated with lower cognitive scores, while only AGEs (β −1.17, <i>p</i> = 0.03) remained a significant predictor in multivariate analysis (Model R2 0.31, <i>p</i> < 0.01). Conclusions: Long-term TC survivors performed worse on cognitive tests compared to controls. Physicians and patients should be informed about timely cardiovascular risk management and testosterone supplementation therapy during follow-up to reduce the risk of cognitive impairment. Trial Registration: NCT02572934.Johannes StelwagenAndrea T. MeulemanSjoukje LubbertsGerrie SteursmaLara M. KruytJan W. DonkerbroekCoby MeijerAnnemiek M. E. WalenkampJoop D. LefrandtSandra E. RakersRients B. HuitemaMarianne A. A. de JongErwin M. WiegmanAlfons C. M. van den BerghIgle J. de JongJoost A. Agelink van RentergemSanne B. SchagenJanine NuverJourik A. GietemaMDPI AGarticletesticular cancercancer survivorslate toxicityneurocognitive impairmentNeoplasms. Tumors. Oncology. Including cancer and carcinogensRC254-282ENCancers, Vol 13, Iss 5675, p 5675 (2021) |
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EN |
| topic |
testicular cancer cancer survivors late toxicity neurocognitive impairment Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282 |
| spellingShingle |
testicular cancer cancer survivors late toxicity neurocognitive impairment Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282 Johannes Stelwagen Andrea T. Meuleman Sjoukje Lubberts Gerrie Steursma Lara M. Kruyt Jan W. Donkerbroek Coby Meijer Annemiek M. E. Walenkamp Joop D. Lefrandt Sandra E. Rakers Rients B. Huitema Marianne A. A. de Jong Erwin M. Wiegman Alfons C. M. van den Bergh Igle J. de Jong Joost A. Agelink van Rentergem Sanne B. Schagen Janine Nuver Jourik A. Gietema Cognitive Impairment in Long-Term Survivors of Testicular Cancer More Than 20 Years after Treatment |
| description |
Background: Impaired cognition can be a late effect after treatment in long-term testicular cancer (TC) survivors, negatively affecting their daily life. However, little data is available beyond 20 years post-treatment. We assessed cognitive impairment in very long-term TC survivors after CT or RT and compared the results with stage I TC survivors and controls. Methods: In this cross-sectional multicenter cohort study, we enrolled TC survivors (treated with orchiectomy followed by CT or RT or orchiectomy only)—with a follow-up duration ≥ 20 years—and age-matched healthy controls. Cognitive testing included the Auditory Verbal Learning Test, Letter Fluency Test, Category Fluency Test, and Trail Making Test. We used fasting blood samples to assess the presence of hypogonadism and measured cardiovascular aging parameters, including carotid pulse wave velocity (c-PWV) and advanced glycation end products (AGEs). Results: We included 184 TC survivors (66 CT patients, 53 RT patients, and 65 orchiectomy-only patients) and 70 healthy controls. The median follow-up was 26 years (range: 20–42). TC survivors had a lower combined score of the cognitive tests (mean cumulative Z-score −0.85; 95% CI −1.39 to −0.33) compared to controls (mean 0.67; 95% CI −0.21 to 1.57, <i>p</i> < 0.01). In univariate analysis, the presence of hypogonadism (β −1.50, <i>p</i> < 0.01), high c-PWV (β −0.35, <i>p</i> = 0.09), and high AGEs (β −1.27, <i>p</i> = 0.02) were associated with lower cognitive scores, while only AGEs (β −1.17, <i>p</i> = 0.03) remained a significant predictor in multivariate analysis (Model R2 0.31, <i>p</i> < 0.01). Conclusions: Long-term TC survivors performed worse on cognitive tests compared to controls. Physicians and patients should be informed about timely cardiovascular risk management and testosterone supplementation therapy during follow-up to reduce the risk of cognitive impairment. Trial Registration: NCT02572934. |
| format |
article |
| author |
Johannes Stelwagen Andrea T. Meuleman Sjoukje Lubberts Gerrie Steursma Lara M. Kruyt Jan W. Donkerbroek Coby Meijer Annemiek M. E. Walenkamp Joop D. Lefrandt Sandra E. Rakers Rients B. Huitema Marianne A. A. de Jong Erwin M. Wiegman Alfons C. M. van den Bergh Igle J. de Jong Joost A. Agelink van Rentergem Sanne B. Schagen Janine Nuver Jourik A. Gietema |
| author_facet |
Johannes Stelwagen Andrea T. Meuleman Sjoukje Lubberts Gerrie Steursma Lara M. Kruyt Jan W. Donkerbroek Coby Meijer Annemiek M. E. Walenkamp Joop D. Lefrandt Sandra E. Rakers Rients B. Huitema Marianne A. A. de Jong Erwin M. Wiegman Alfons C. M. van den Bergh Igle J. de Jong Joost A. Agelink van Rentergem Sanne B. Schagen Janine Nuver Jourik A. Gietema |
| author_sort |
Johannes Stelwagen |
| title |
Cognitive Impairment in Long-Term Survivors of Testicular Cancer More Than 20 Years after Treatment |
| title_short |
Cognitive Impairment in Long-Term Survivors of Testicular Cancer More Than 20 Years after Treatment |
| title_full |
Cognitive Impairment in Long-Term Survivors of Testicular Cancer More Than 20 Years after Treatment |
| title_fullStr |
Cognitive Impairment in Long-Term Survivors of Testicular Cancer More Than 20 Years after Treatment |
| title_full_unstemmed |
Cognitive Impairment in Long-Term Survivors of Testicular Cancer More Than 20 Years after Treatment |
| title_sort |
cognitive impairment in long-term survivors of testicular cancer more than 20 years after treatment |
| publisher |
MDPI AG |
| publishDate |
2021 |
| url |
https://doaj.org/article/16becf8f36a942829bc04930df6e0da4 |
| work_keys_str_mv |
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| _version_ |
1718412760090411008 |