Chronic fatigue in 812 testicular cancer survivors during long-term follow-up: increasing prevalence and risk factors.
BACKGROUND
Chronic fatigue (CF) has been reported to be slightly more prevalent in testicular cancer survivors (TCSs) than in the general population. In this study, we wished to explore possible determinants of CF in TCSs median 12 (survey I) and 19 years (survey II) after treatment, in particular the relation to late effects after treatment.


METHODS
Overall, 812 TCSs treated between 1980 and 1994 provided blood samples (testosterone and luteinizing hormone) and completed questionnaires at survey I (1998-2002) and survey II (2007-2008). Hormone levels were categorized according to quartile thresholds for decadal age groups of controls. Associations between CF and possible risk factors, including the Hospital Anxiety and Depression Scale (HADS), treatment, physical activity, hormone levels, neurotoxicity, and comorbidity, were analyzed by logistic regression.


RESULTS
Prevalence of CF increased from 15% at survey I to 27% at survey II (P < 0.001). At survey II, risk for CF was increased three- to four-fold for high levels of neuropathy compared with no neuropathy, and two- to three-fold for high levels of Raynaud-like phenomena, and having testosterone levels in the lowest quartile, while being moderately and highly physically active, had a protective effect. Risk for CF in TCSs with higher levels of HADS-Anxiety and HADS-Depression was increased two- to five-fold, respectively.


CONCLUSIONS
The increasing prevalence of CF in TCSs is a novel finding. Lifestyle interventions, early detection and treatment of depression and anxiety, and possibly testosterone substitution might reduce the risk of CF. Extended long-term follow-up seems to be important.
National Advisory Unit on Late Effects after Cancer Treatment, Oslo University Hospital, Oslo.
M
M
Sprauten
Department of Oncology, Institute of Clinical Medicine, University of Tromsø, Tromsø Department of Oncology, University Hospital of North Norway, Tromsø
H S
HS
Haugnes
Department of Oncology, Haukeland University Hospital, Bergen.
M
M
Brydøy
National Advisory Unit on Late Effects after Cancer Treatment, Oslo University Hospital, Oslo.
C
C
Kiserud
The Cancer Clinic, St Olavs University Hospital, Trondheim.
T
T
Tandstad
Department of Medical Biochemistry, Oslo University Hospital, Oslo Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo.
T
T
Bjøro
Fürst Medical Laboratory, Oslo.
J
J
Bjerner
National Advisory Unit on Late Effects after Cancer Treatment, Oslo University Hospital, Oslo.
M
M
Cvancarova
National Advisory Unit on Late Effects after Cancer Treatment, Oslo University Hospital, Oslo.
S D
SD
Fosså
Department of Oncology, Oslo University Hospital, Oslo Department of Oncology, Akershus University Hospital, Lørenskog, Norway jan.oldenburg@medisin.uio.no.
J
J
Oldenburg
D000293:Adolescent; D000328:Adult; D000368:Aged; D001007:Anxiety / Q000453:epidemiology* / Q000209:etiology; D002908:Chronic Disease; D015897:Comorbidity; D003863:Depression / Q000453:epidemiology* / Q000209:etiology; D005221:Fatigue / Q000453:epidemiology* / Q000209:etiology*; D005500:Follow-Up Studies; D006801:Humans; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D009373:Neoplasms, Germ Cell and Embryonal / Q000150:complications* / Q000503:physiopathology / Q000628:therapy; D009664:Norway / Q000453:epidemiology; D015995:Prevalence; D011379:Prognosis; D012307:Risk Factors; D017741:Survivors / Q000706:statistics & numerical data*; D013736:Testicular Neoplasms / Q000150:complications* / Q000503:physiopathology / Q000628:therapy; D013739:Testosterone / Q000097:blood; D055815:Young Adult
D013739:Testosterone
fatigue; hypogonadism; physical activity; survivorship; testicular cancer; testosterone