Excessive annual BMI increase after chemotherapy among young survivors of testicular cancer

Abstract

Increased body mass index (BMI) is claimed to be a complication among survivors of testicular cancer (TCSs), especially after receiving cisplatin-based chemotherapy. This study compares changes in BMI (kg m À2 ) in TCSs with those observed in age-matched men from the population (controls). Associations between treatment, age and potential BMI changes were sought. In 1999, a survey was performed at the NRH of 444 unilaterally orchiectomised TCSs treated from 1980 to 1990. BMI at survey was recorded in each TCS. Information on principal treatment (surgery only: SURG; radiotherapy only: RAD; chemotherapy 7 surgery or radiotherapy: CHEM7) and pretreatment BMI was retrieved from the medical records. The age-matched controls had BMI measurements from population surveys from 1985 and 1996. The annual BMI increase was calculated based on the difference in the two BMI measurements divided by observation time. TCSs displayed a lower pretreatment mean BMI than the controls, whereas no difference was found post-treatment. However, the annual BMI increase in TCSs exceeded that of the controls (0.19 vs 0.15, P ¼ 1.4 Â 10 À7 ). The SURG and CHEM7 groups showed the greatest annual BMI increase. The multiple regression analysis showed that young TC patients who received chemotherapy displayed an excessive annual BMI increase. Oncologists and young TCSs should be aware of the risk of excessive BMI increase, in particular, after the use of chemotherapy.

Reply: Changes in BMI after treatment of testicular cancer are due to age and hormonal function and not chemotherapy

“…Our results from the multivariate regression analysis indicated that in survivors of testicular cancer (TCSs), chemotherapy had an impact on the annual BMI increase independent of age and that the surgery group displayed no significant annual BMI increase (Nord et al, 2003). However, it only explained 8% of our observations as compared to the normal population, thus indicating a multifactorial background for the annual BMI increase.…”

Changes in BMI after treatment of testicular cancer are due to age and hormonal function and not chemotherapy

“…We read with interest the article of Nord et al (2003) who reported excessive increases in body mass index (BMI) after chemotherapy in long-term survivors of testicular cancer. We believe this study presents important data but do not believe that the data presented fully support the authors' conclusions.…”

Increased mortality rates in young and middle-aged patients with malignant germ cell tumours

“…After such cytostatic treatment, patients more often had increased serum levels of cholesterol, weight gain, hypertension and decreased renal function (Hansen et al, 1988;Ellis et al, 1992;Raghavan et al, 1992;Bokemeyer et al, 1996;Nord et al, 2003a) than the age-matched general population, or compared to MGCT patients treated by surgery only. Our data support the view of increase of diseases of the circulatory system in patients with MGCT, as our complete cohort of MGCT patients indeed displayed a marginally increased risk of dying from circulatory diseases (SMR: 1.2 (95% CI: 1.0 -1.5)).…”

“…1965 1970 1975 1980 1985 1990 1995 2000 1965 1970 1975 1980 1985 1990 1995 One should also discuss alternative and treatment-independent causes leading to cardiovascular events and high-risk factors in testicular cancer survivors. Slight hypogonadism as reduced testosterone serum levels and/or increased LH serum levels are seen in about 15% of these patients (Huddart et al, 2003;Nord et al, 2003a). Hypogonadism may by itself lead to premature ageing with its consequences on disorders of the circulatory system, including increased BMI, serum lipid disturbances and hypertension.…”

“…These solid cancers develop mostly 10 years or more after radiotherapy, when patients are no longer followed up intensively by their primarily responsible oncological unit. Epidemiologically less established are observations on late adverse events related to obesity, hypercholesterolaemia and decreased kidney function and to cardiovascular events (Hansen et al, 1988;Ellis et al, 1992;Raghavan et al, 1992;Bokemeyer et al, 1996;Fosså et al, 1989;Meinardi et al, 2000;Huddart et al, 2003;Fosså et al, 2003;Nord et al, 2003a). Single-centre reports have indicated that such conditions may be associated with the modern treatment of MGCT, in particular with the use of cisplatin-based chemotherapy.…”