Long-term quality of life of testicular cancer survivors differs according to applied adjuvant treatment and tumour type

<jats:title>Abstract</jats:title><jats:sec> <jats:title>Purpose</jats:title> <jats:p>To evaluate the quality of life (QoL) in long-term testicular cancer (TC) survivors.</jats:p> </jats:sec><jats:sec> <jats:title>Methods</jats:title> <jats:p>QoL was assessed in TC survivors treated between March 1976 and December 2004 (<jats:italic>n</jats:italic> = 625) using the EORTC-QLQ-C30 questionnaire, including a TC module. The assessment was performed at two time points (2006: response rate: <jats:italic>n</jats:italic> = 201/625 (32.2%), median follow-up (FU): 12.9 years (range 1.1–30.9); 2017: response rate: <jats:italic>n</jats:italic> = 95/201 (47.3%), median FU: 26.2 years (range: 13.0–41.2)). TC survivors were grouped according to treatment strategy, tumour entity, clinical stage and prognosis group. Linear and multiple linear regression analyses were performed, with age and time of follow-up as possible confounders.</jats:p> </jats:sec><jats:sec> <jats:title>Results</jats:title> <jats:p>Radiation therapy (RT) compared to retroperitoneal lymph node dissection (RPLND) was associated with a higher impairment of physical function (2017: <jats:italic>β</jats:italic> =  − 9.038; t(84) =  − 2.03; <jats:italic>p</jats:italic> = 0.045), role function (2017: <jats:italic>β</jats:italic> =  − 12.764; t(84) =  − 2.00; <jats:italic>p</jats:italic> = 0.048), emotional function (2006: <jats:italic>β</jats:italic> =  − 9.501; t(183) =  − 2.09; <jats:italic>p</jats:italic> = 0.038) and nausea (2006: <jats:italic>β</jats:italic> = 6.679; t(185) = 2.70; <jats:italic>p</jats:italic> = 0.008). However, RT was associated with a lower impairment of sexual enjoyment (2017: symptoms: <jats:italic>β</jats:italic> = 26.831; t(64) = 2.66; <jats:italic>p</jats:italic> = 0.010; functional: <jats:italic>β</jats:italic> = 22.983; t(65) = 2.36; <jats:italic>p</jats:italic> = 0.021). Chemotherapy (CT), compared to RPLND was associated with a higher impairment of role (2017: <jats:italic>β</jats:italic> =  − 16.944; t(84) =  − 2.62; <jats:italic>p</jats:italic> = 0.011) and social function (2017: β =  − 19.160; t(79) =  − 2.56; <jats:italic>p</jats:italic> = 0.012), more insomnia (2017: <jats:italic>β</jats:italic> = 19.595; t(84) = 2.25; <jats:italic>p</jats:italic> = 0.027) and greater concerns about infertility (2017: β = 19.830; t(80) = 2.30; <jats:italic>p</jats:italic> = 0.024). In terms of tumour type, nonseminomatous germ cell tumour (NSGCT) compared to seminoma survivors had significantly lower impairment of nausea (2006: <jats:italic>β</jats:italic> =  − 4.659; t(187) =  − 2.17; <jats:italic>p</jats:italic> = 0.031), appetite loss (2006: β =  − 7.554; t(188) =  − 2.77; <jats:italic>p</jats:italic> = 0.006) and future perspective (2006: <jats:italic>β</jats:italic> =  − 12.146; t(175) =  − 2.08; <jats:italic>p</jats:italic> = 0.039). On the other hand, surviving NSGCT was associated with higher impairment in terms of sexual problems (2006: <jats:italic>β</jats:italic> = 16.759; t(145) = 3.51; <jats:italic>p</jats:italic> < 0.001; 2017: <jats:italic>β</jats:italic> = 21.207; t(63) = 2.73; <jats:italic>p</jats:italic> = 0.008) and sexual enjoyment (2017: <jats:italic>β</jats:italic> =  − 24.224; t(66) =  − 2.76; <jats:italic>p</jats:italic> = 0.008).</jats:p> </jats:sec><jats:sec> <jats:title>Conclusions</jats:title> <jats:p>The applied adjuvant treatment and the tumour entity had a significant impact on the long-term QoL of TC survivors, even more than 25 years after the completion of therapy. Both RT and CT had a negative impact compared to survivors treated with RPLND, except for sexual concerns. NSGCT survivors had a lower impairment of QoL compared to seminoma survivors, except in terms of sexual concerns.</jats:p> </jats:sec><jats:sec> <jats:title>Implications for Cancer Survivors</jats:title> <jats:p>Implications for cancer survivors are to raise awareness of aspects of long-term and late effects on QoL in TC survivors; offer supportive care, such as psycho-oncological support or lifestyle modification, if a deterioration in QoL is noticed; and avoid toxic treatment without compromising a cure whenever possible.</jats:p> </jats:sec>