Quality-of-life issues in the treatment of testicular cancer

Quality of life (QOL) issues in testis cancer have recently assumed great i mportance for both physicians and patients. Since most of the patients are going to be long-term survivors, with modern therapeutic approaches, psycho social difficulties and sexual life problems may become one of the major lo ng-term complications of testis cancer treatment. QOL studies available dem onstrate that approximately 10% of the patients will suffer from enduring l ong-term psychological problems, namely anxiety, depression, fatigue, and d isrupted intimate relationships. Since these problems develop unrelated to the therapeutic approach, one has to develop risk profiles predicting psych ological illness, such as with psychological counseling, prior to the initi ation of the therapy. Impairment of sexual life and infertility distress re present other long-term sequelae of testis cancer treatment. The highest in cidence of sexual dysfunction develops within the first 6 months following therapy, with most patients recovering within the next 3 years, resulting i n a 15% rate of long-term sexual dysfunction. This relatively high frequenc y of sexual problems warrants an adequate counseling before and after thera py. Future perspectives of QOL research in testis cancer has to concentrate on the development of a site- specific questionnaire. Since the different therapeutic strategies in clinical stage 1 testis cancer result in the same high cure rates but may encounter various levels of psychosocial distress, QOL appears to represent the most important endpoint end of different trea tment modalities in the clinical setting of different treatment modalities and QOL documentation must be integrated in all clinical study protocolls. QOL studies are important issues in the evaluation of each new future metho d of treatment modality going to be established for testis cancer.