Kerns SL, et al. - The cumulative burden of morbidity (CBM) was assessed among > 1,200 testicular cancer survivors and using factor analysis, the co-occurrence of adverse health outcomes (AHOs) was determined. CBM score was high or very high/severe in nearly 20% patients, whereas approximately 80% scored medium or low/very low. Survivors in need for closer monitoring could be detected by factors associated with higher CBM, which included four cycles of either ifosfamide, etoposide, and cisplatin or bleomycin, etoposide, and cisplatin, older attained age, current disability leave, less than a college education, and current or former smoking. Six significant AHO clusters were also identified. If confirmed, identified AHO clusters could guide the development of survivorship care strategies.

• This study included participants of ≤ 55 years of age at diagnosis, finished first-line chemotherapy ≥ 1 year previously, completed a comprehensive questionnaire, and underwent physical examination.
• Researchers abstracted treatment data from medical records.
• A CBM score encompassed the number and severity of AHOs, with ordinal logistic regression used to assess associations with exposures.
• In order to determine which AHOs co-occurred, nonlinear factor analysis and the nonparametric dimensionality evaluation to enumerate contributing traits procedure were carried out.

• A total of 1,214 participants were included, of those, approximately 20% had a high (15%) or very high/severe (4.1%) CBM score, whereas approximately 80% scored medium (30%) or low/very low (47%).
• Increased risks of higher scores were shown to be related to 4 cycles of either ifosfamide, etoposide, and cisplatin (odds ratio [OR], 1.96; 95% CI, 1.04 to 3.71) or bleomycin, etoposide, and cisplatin (OR, 1.44; 95% CI, 1.04 to 1.98), older attained age (OR, 1.18; 95% CI, 1.10 to 1.26), current disability leave (OR, 3.53; 95% CI, 1.57 to 7.95), less than a college education (OR, 1.44; 95% CI, 1.11 to 1.87), and current or former smoking (OR, 1.28; 95% CI, 1.02 to 1.63).
• After either chemotherapy regimen (P= .36), no difference was noted in CBM score.
• Asian race (OR, 0.41; 95% CI, 0.23 to 0.72) and vigorous exercise (OR, 0.68; 95% CI, 0.52 to 0.89) were noted to be protective.
• Six significant AHO clusters were identified via variable clustering analyses (Χ² P < .001): hearing loss/damage, tinnitus (OR, 16.3); hyperlipidemia, hypertension, diabetes (OR, 9.8); neuropathy, pain, Raynaud phenomenon (OR, 5.5); cardiovascular and related conditions (OR, 5.0); thyroid disease, erectile dysfunction (OR, 4.2); and depression/anxiety, hypogonadism (OR, 2.8).