Cardiovascular disease and second cancer risk in testicular cancer survivors

In the last two decades more attention has been drawn to late effects of testicular cancer treatment and on testicular cancer survivorship. In 2010 an international expert group raised awareness about important gaps in knowledge with respect to risk assessment of site-specific second malignancies and different cardiovascular diseases in patients with testicular cancer treated from 1976 onwards. The studies in this thesis aimed to address several of these knowledge gaps in late effects of treatment for testicular cancer and specifically assess incidence and mortality from both second solid malignancies and cardiovascular diseases in patients treated in the platinum era (1976+). Only a decade ago, it was still not known that patients who were treated for their testicular cancer with contemporary treatments, in particular those treated with platinum-containing chemotherapy, were at an increased risk of specific solid malignancies or ischemic heart disease. We observed that testicular cancer survivors treated with platinum-containing chemotherapy experience increased morbidity and mortality from gastrointestinal malignancies as well as ischemic heart disease and heart failure. A significant dose-response relationship was observed for platinum dose and risk of solid cancer, ischemic heart disease and heart failure as well. No safe dose can be distilled from these results. We also observed that approximately 35% of our participants to the site visit have the metabolic syndrome according to the NCAP ATP III definition, which is a common risk factor for cardiovascular disease. We advocate the evaluation of effectiveness of screening for colorectal malignancies for patients diagnosed with testicular cancer who were exposed to ≥3 cycles of platinum-containing chemotherapy. We also recommend more vigorous cardiovascular risk management for patients with testicular cancer who have cardiovascular risk factors and/or who were exposed to platinum, right from the start of treatment. Furthermore, adherence to a healthy and active lifestyle is strongly recommended. Further research is needed to better identify survivors at high risk of cardiovascular disease. This may result in reduction of the risk of some late life-threatening adverse effects of testicular cancer treatment.