Mental Health Burden of a Testicular Cancer Diagnosis: Insights from a Large Claims Database

Patients with early stage testicular cancer have an excellent prognosis. Despite excellent cure rates, the diagnosis carries substantial psychological significance due to its occurrence during formative years of life. Survivorship in patients with testicular cancer has been understudied, especially in the context of mental health. The negative impact on cancer survivorship is largely attributed to the toxicity of systemic therapy, fear of recurrence, and potential impact on hormone function. However, localized stage I testicular cancer is unique in that it has a brief treatment duration, a high cure rate, and a relatively low risk of recurrence. These characteristics raise important questions about the incidence of mental health outcomes in early-stage survivors, many of whom are young men who are already at a higher baseline risk for mental health disease.

In this study, we utilized a large claims database to compare the incidence of mental health disorders in patients following a diagnosis of stage I testis cancer. We excluded any patient who recurred for stage I disease, thus emphasizing a cohort of patients who were essentially cured by orchiectomy. We then compared the incidence of newly diagnosed mental health disorders in this group to a matched cohort of patients who had an orchiectomy for a benign etiology. A propensity score match was performed to control for factors that can impact mental health outcomes, including age, ethnicity, and prior testosterone or antidepressant use. Our study found that patients diagnosed with stage I testicular cancer and cured by orchiectomy had significantly higher rates of mental health disorders, specifically a 2.7-fold higher relative risk of developing depression, 2.5-fold higher risk of anxiety, and 2.5-fold higher risk of sleep disorders compared to the control population.

This data highlights that even in a population of early-stage testicular cancer patients who have been cured, mental health disorders were significant and prevalent. These findings underscore the critical importance of mental health evaluation even in early-stage disease, an area that remains understudied and requires further dedicated investigation. Furthermore, it is essential that urologists, who are often the primary providers for these patients, actively screen for these disorders and initiate a multidisciplinary approach involving mental health professionals to ensure comprehensive survivorship care.

Written by: Jersey-Kate Castillo,¹ and Muhannad Alsyouf,^1,2

Department of Urology, Loma Linda University Health, Loma Linda, CA
Division of Urology, Riverside University Health System, Moreno Valley, CA

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