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Noh H, Anota A, Mongondry R, Meyrand R, Dupuis C, Schiffler C, Marijnen P, Rinaldi S, Lachuer J, Keski-Rahkonen P, Gunter MJ, Fléchon A, Fervers B, Pérol O. Impact of a one-year supervised physical activity program on long-term cancer-related fatigue and mediating effects of the gut microbiota in metastatic testicular cancer patients: protocol of the prospective multicentre, randomized controlled phase-III STARTER trial. BMC Cancer 2024; 24:84. [PMID: 38225551 PMCID: PMC10790440 DOI: 10.1186/s12885-024-11824-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 01/02/2024] [Indexed: 01/17/2024] Open
Abstract
BACKGROUND Testicular germ cell tumours (TGCTs) are the most common malignancy in men aged 15-40 years, with increasing incidence worldwide. About 33 ~ 50% of the patients present with metastatic disease at diagnosis. TGCT survivors experience short- and long-term sequelae, including cancer-related fatigue (CRF). Physical activity (PA) has established effects on reducing CRF and other sequelae and improving health-related quality of life (HRQoL). However, its impact on TGCT survivors has so far received little attention. The gut microbiota plays a crucial role in various physiological functions, including cognition and metabolism, and may mediate the effects of PA on CRF and other sequelae, but this has not been investigated in randomized controlled trials. METHODS This national, multicentre, phase-III trial will evaluate the impact of a one-year supervised PA program on CRF and other short- and long-term sequelae in metastatic TGCT patients receiving cisplatin-based chemotherapy combined with etoposide+/-bleomycin. It will also investigate potential mediating effects of the gut microbiota and its metabolites involved in the gut-brain axis on the relationship between PA and CRF and other sequelae. A total of 236 men ≥ 18 years of age with metastatic TGCT (seminoma and non-seminoma) will be enrolled before starting first-line chemotherapy in several French hospitals. The primary (CRF) and secondary (cognitive/psychological/metabolic sequelae, HRQoL, etc.) outcomes and gut microbiota and relevant metabolites will be assessed at inclusion, during and at the end of the one-year intervention, and annually until 10 years since inclusion to assess long-term sequelae, more specifically CRF, cardiovascular toxicities, and second primary cancer occurrence in this population. DISCUSSION This trial will provide comprehensive and novel insights into the effects of a long-term supervised PA program on CRF and other sequelae in metastatic TGCT patients receiving first-line chemotherapy. It will also contribute to understanding the potential role of the gut microbiota and its metabolites in mediating the effects of PA on these outcomes. The findings of this study will help the development of effective PA interventions to improve the health of TGCT survivors and may have implications for other cancer populations as well. TRIAL REGISTRATION The study was registered on ClinicalTrials.gov (NCT05588700) on 20 Oct. 2022.
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Affiliation(s)
- Hwayoung Noh
- Departement of Prevention Cancer Environment, Léon Bérard Cancer Centre, Lyon, France.
- INSERM U1296, Léon Bérard Cancer Centre, Lyon, France.
- Nutrition and Metabolism Branch, International Agency for Research on Cancer (IARC-WHO), Lyon, France.
| | - Amélie Anota
- Direction of Clinical Research and Innovation, Léon Bérard Cancer Centre, Lyon, France
| | - Rodolf Mongondry
- Departement of Prevention Cancer Environment, Léon Bérard Cancer Centre, Lyon, France
| | - Renaud Meyrand
- Departement of Prevention Cancer Environment, Léon Bérard Cancer Centre, Lyon, France
| | - Carmen Dupuis
- Departement of Prevention Cancer Environment, Léon Bérard Cancer Centre, Lyon, France
| | - Camille Schiffler
- Direction of Clinical Research and Innovation, Léon Bérard Cancer Centre, Lyon, France
| | - Philippe Marijnen
- Departement of Prevention Cancer Environment, Léon Bérard Cancer Centre, Lyon, France
| | - Sabina Rinaldi
- Nutrition and Metabolism Branch, International Agency for Research on Cancer (IARC-WHO), Lyon, France
| | - Joel Lachuer
- INSERM U1052, Cancer Research Center of Lyon (CRCL), University Lyon 1, Lyon, France
- ProfileXpert, SFR santé Lyon-Est, CNRS UMR-S3453, INSERM US7, Lyon, France
| | - Pekka Keski-Rahkonen
- Nutrition and Metabolism Branch, International Agency for Research on Cancer (IARC-WHO), Lyon, France
| | - Marc J Gunter
- Nutrition and Metabolism Branch, International Agency for Research on Cancer (IARC-WHO), Lyon, France
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, W2 1PG, London, UK
| | - Aude Fléchon
- Department of Medical Oncology, Léon Bérard Cancer Centre, Lyon, France
| | - Béatrice Fervers
- Departement of Prevention Cancer Environment, Léon Bérard Cancer Centre, Lyon, France
- INSERM U1296, Léon Bérard Cancer Centre, Lyon, France
| | - Olivia Pérol
- Departement of Prevention Cancer Environment, Léon Bérard Cancer Centre, Lyon, France
- INSERM U1296, Léon Bérard Cancer Centre, Lyon, France
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Sanchez VA, Shuey MM, Dinh PC, Monahan PO, Fosså SD, Sesso HD, Dolan ME, Einhorn LH, Vaughn DJ, Martin NE, Feldman DR, Kroenke K, Fung C, Frisina RD, Travis LB. Patient-Reported Functional Impairment Due to Hearing Loss and Tinnitus After Cisplatin-Based Chemotherapy. J Clin Oncol 2023; 41:2211-2226. [PMID: 36626694 PMCID: PMC10489421 DOI: 10.1200/jco.22.01456] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 10/25/2022] [Accepted: 11/16/2022] [Indexed: 01/12/2023] Open
Abstract
PURPOSE Cisplatin is widely used and highly ototoxic, but patient-reported functional impairment because of cisplatin-related hearing loss (HL) and tinnitus has not been comprehensively evaluated. PATIENTS AND METHODS Testicular cancer survivors (TCS) given first-line cisplatin-based chemotherapy completed validated questionnaires, including the Hearing Handicap Inventory for Adults (HHIA) and Tinnitus Primary Function Questionnaire (TPFQ), each of which quantifies toxicity-specific functional impairment. Spearman correlations evaluated associations between HL and tinnitus severity and level of functional handicap quantified with the HHIA and TPFQ, respectively. Associations between HL or tinnitus and five prespecified adverse health outcomes (cognitive dysfunction, fatigue, depression, anxiety, and overall health) were evaluated. RESULTS HL and tinnitus affected 137 (56.4%) and 147 (60.5%) of 243 TCS, respectively. Hearing aids were used by 10% TCS (14/137). Of TCS with HL, 35.8% reported clinically significant functional impairment. Severe HHIA-assessed functional impairment was associated with cognitive dysfunction (odds ratio [OR], 10.62; P < .001), fatigue (OR, 5.48; P = .003), and worse overall health (OR, 0.19; P = .012). Significant relationships existed between HL severity and HHIA score, and tinnitus severity and TPFQ score (P < .0001 each). TCS with either greater hearing difficulty or more severe tinnitus were more likely to report cognitive dysfunction (OR, 5.52; P = .002; and OR, 2.56; P = .05), fatigue (OR, 6.18; P < .001; and OR, 4.04; P < .001), depression (OR, 3.93; P < .01; and OR, 3.83; P < .01), and lower overall health (OR, 0.39; P = .03; and OR, 0.46; P = .02, respectively). CONCLUSION One in three TCS with HL report clinically significant functional impairment. Follow-up of cisplatin-treated survivors should include routine assessment for HL and tinnitus. Use of the HHIA and TPFQ permit risk stratification and referral to audiologists as needed, since HL adversely affects functional status and is the single largest modifiable risk factor for cognitive decline and dementia in the general population.
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Affiliation(s)
| | - Megan M. Shuey
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Paul C. Dinh
- Department of Medical Oncology, Indiana University, Indianapolis, IN
| | - Patrick O. Monahan
- Department of Biostatistics and Health Data Science, Indiana University, Indianapolis, IN
| | | | - Howard D. Sesso
- Division of Preventive Medicine, Brigham and Women's Hospital, Boston, MA
| | | | | | - David J. Vaughn
- Department of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Neil E. Martin
- Division of Preventive Medicine, Brigham and Women's Hospital, Boston, MA
| | | | | | - Chunkit Fung
- J.P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY
| | | | - Lois B. Travis
- Department of Medical Oncology, Indiana University, Indianapolis, IN
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Anderson D, Razzak AN, McDonald M, Cao D, Hasoon J, Viswanath O, Kaye AD, Urits I. Mental Health in Urologic Oncology. Health Psychol Res 2022; 10:37518. [DOI: 10.52965/001c.37518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
This article is a systematic review of mental health in urologic oncology patients with prostate cancer (PCa), bladder cancer (BC), renal cell carcinoma (RCC), testicular cancer (TC), or penile cancer (PeCa). For all pathologies, a focus on increasing quality of life post-treatment demonstrated a positive impact in reducing Mental Health Illness (MHI) prevalence. Cancer specific mental health care may be given to patients to reduce suicide risk in BC patients and sexual identify and masculinity counseling may improve mental health for TC or PeCa patients. In order to better accommodate patient’s mental health needs when undergoing GU cancer treatment, we recommend incorporation of mental health metrics such as questionnaires to assess early treatment of MHI, a greater emphasis on psychosocial support with the patient’s loved ones, peers, and healthcare team, alongside advising healthy habits such as exercise which has been shown to drastically reduce MHI incidence across all pathologies. We hope that these measures conducted by urologists and oncologists, alongside possible coordination with psychiatrists and psychologists for psychotherapy, psychopharmacology, and neuro-stimulation treatment modems may be helpful in the long term to reduce MHI incidence in urology oncology patients. Given the higher incidence of MHI in oncology patients and in the patient population after the Covid-19 pandemic, MHI awareness in the sphere of urologic oncologic treatment continues to be crucial when creating a collaborative treatment platform for patients.
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Affiliation(s)
| | | | | | | | | | - Omar Viswanath
- Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School; Valley Anesthesiology and Pain Consultants, Envision Physician Services; Department of Anesthesiology, University of Arizona College of Medicine Phoenix;Department of Anesthesiology, Creighton University School of Medicine
| | | | - Ivan Urits
- Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School; Department of Anesthesiology, Louisiana State University Health Shreveport
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Rovito MJ, Craycraft M, Adams WB, Maresca M, Saab MM, Cary C, Gooljar C, Martinez S, Abu Zanet R. A Cross-Sectional Analysis of Testicular Cancer Symptom Recognition and Stage of Diagnosis. Am J Mens Health 2022; 16:15579883221104900. [PMID: 35723132 PMCID: PMC9344164 DOI: 10.1177/15579883221104900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
There is a need to further explore the relationship between atypical symptom
reporting and stage diagnosis to help develop a clearer defined list of possible
testicular cancer (TC) symptoms that could assist physicians diagnose the
disease earlier. A cross-sectional study was employed to explore possible
associations between TC symptom presentation and stage of diagnosis. An original
40-item survey was distributed among 698 TC survivors to determine the potential
impact of several risk factors, experiences, and behaviors upon diagnosis. This
analysis aimed to explore how certain patient-driven experiences (e.g.,
symptoms, perceptions, and behaviors) could serve as catalysts for seeking
medical care for testicular health concerns. Experiencing hot flashes or having
no symptoms had a positive association with later-stage diagnosis while change
in shape had a significant negative association with later-stage diagnosis.
While the logistic regression model explained relatively low variance in the
data (R2 = .1415), it was statistically significant
(χ2p < .001). Pain (odds ratio [OR] = 1.6524,
p < .05), hot flashes (OR = 5.7893, p
< .01), and no symptoms experienced (OR = 12.4836, p <
.01) were all significant predictors of a more advanced stage diagnosis. The
concern around uncommon/atypical symptoms are that they are indistinct and do
not serve as clear signs that TC is present. However, perhaps in tandem with
other more overt symptoms, their discovery can serve in a more confirmatory role
for a suspect case. If observed with other uncommonly reported symptoms, these
uncommon symptoms could provide another pathway in the TC diagnostic process.
Clinical and patient education is warranted to increase awareness of uncommon TC
symptoms.
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Affiliation(s)
- Michael J Rovito
- Testicular Cancer Research Collaborative, Department of Health Sciences, College of Health Professions and Sciences, University of Central Florida, Orlando, FL, USA
| | | | - Wesley B Adams
- Testicular Cancer Research Collaborative, Department of Health Sciences, College of Health Professions and Sciences, University of Central Florida, Orlando, FL, USA
| | - Michael Maresca
- Testicular Cancer Research Collaborative, Department of Health Sciences, College of Health Professions and Sciences, University of Central Florida, Orlando, FL, USA
| | - Mohamad M Saab
- Catherine McAuley School of Nursing and Midwifery, Brookfield Health Sciences Complex, University College Cork, Cork, Ireland
| | - Clint Cary
- Health Simon Cancer Center, Indiana University, Indianapolis, IN, USA
| | - Chayna Gooljar
- Testicular Cancer Research Collaborative, Department of Health Sciences, College of Health Professions and Sciences, University of Central Florida, Orlando, FL, USA
| | - Sydney Martinez
- Testicular Cancer Research Collaborative, Department of Health Sciences, College of Health Professions and Sciences, University of Central Florida, Orlando, FL, USA
| | - Rama Abu Zanet
- Testicular Cancer Research Collaborative, Department of Health Sciences, College of Health Professions and Sciences, University of Central Florida, Orlando, FL, USA
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