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Testicular cancer linked to high long-term mental health burden


The rates of mental healthcare use were significantly higher for patients versus healthy controls during diagnosis, treatment, and long-term survivorship.

A population-based study showed that following their diagnosis and treatment, patients with testicular cancer experience a high burden of mental health concern that often extends long into survivorship.1

The findings, which were published online in the Journal of Clinical Oncology, showed that the rates of mental healthcare use were significantly higher among testicular cancer patients/survivors compared with the rates for age-, sex-, and geographically matched healthy controls. Outpatient visits for a mental health concern were significantly higher among the testicular cancer population in both the peritreatment (adjusted rate ratio [aRR], 2.45) and post-treatment (aRR, 1.30) periods.

Long-term data showed that over a median follow-up of 12 years, the difference in use of mental healthcare continued.

“The increased rate of mental healthcare use extends into the long-term survivorship period. Survivorship care plans that address the long-term mental healthcare needs of this population are needed,” corresponding author Christopher Booth, MD, Division of Cancer Care and Epidemiology, Queen’s University Cancer Research Institute, Kingston, Ontario, Canada, and coauthors wrote.

The investigators used the Ontario Cancer Registry to identify all cases of patients with testicular cancer who underwent orchiectomy in Ontario, Canada, between 2000 and 2010. Overall, the investigators successfully matched 2,619 cancer cases in a 1:5 ratio to 13,095 healthy controls. The median age for both of the cohorts was 34 years. Regarding primary histology among the testicular cases, 59% were seminoma and 41% were nonseminoma.

Episodes of mental health service use were identified by the investigators using population-level databases. Outpatient mental health service use was defined by the study as any appointment with a psychiatrist or any visit to a general practitioner for the purpose of addressing a mental health concern.

At baseline, the rate of mental health service use was the same between the patients and healthy controls. Overall 533 (20%) of the 2619 patients with testicular cancer had 1 or more outpatient visits for a mental health concern compared with 2314 (18%) of the controls. Severe psychiatric episodes had occurred in 2% of both cohorts.

During the peritreatment period, the rate of outpatient mental health visits was 12% among the testicular cases compared with 4% among the controls. The rates were 57% versus 47%, respectively, during the post-treatment period.

“The difference in mental health service use persisted, and appeared to increase, with longer follow-up,” the investigators wrote.

In their conclusion, the investigators made recommendations based on their findings. “Testicular cancer programs should consider routine screening for mental health distress—especially among patients with a baseline mental health history. Efforts to increase awareness of mental health consequences and ensure that appropriate resources and supports are in place beyond the acute phase of diagnosis and treatment to support the long-term mental health of testicular cancer survivors are warranted.”


1. Raphael MJ, Gupta S, Wei X, et al. Long-term mental health service utilization among survivors of testicular cancer: a population-based cohort study [published online ahead of print January 28, 2021]. J Clin Oncol. doi: 10.1200/JCO.20.02298

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