Chronic fatigue in 812 testicular cancer survivors during long-term follow-up: increasing prevalence and risk factors

Ann Oncol. 2015 Oct;26(10):2133-40. doi: 10.1093/annonc/mdv328. Epub 2015 Aug 11.


Background: Chronic fatigue (CF) has been reported to be slightly more prevalent in testicular cancer survivors (TCSs) than in the general population. In this study, we wished to explore possible determinants of CF in TCSs median 12 (survey I) and 19 years (survey II) after treatment, in particular the relation to late effects after treatment.

Patients and methods: Overall, 812 TCSs treated between 1980 and 1994 provided blood samples (testosterone and luteinizing hormone) and completed questionnaires at survey I (1998-2002) and survey II (2007-2008). Hormone levels were categorized according to quartile thresholds for decadal age groups of controls. Associations between CF and possible risk factors, including the Hospital Anxiety and Depression Scale (HADS), treatment, physical activity, hormone levels, neurotoxicity, and comorbidity, were analyzed by logistic regression.

Results: Prevalence of CF increased from 15% at survey I to 27% at survey II (P < 0.001). At survey II, risk for CF was increased three- to four-fold for high levels of neuropathy compared with no neuropathy, and two- to three-fold for high levels of Raynaud-like phenomena, and having testosterone levels in the lowest quartile, while being moderately and highly physically active, had a protective effect. Risk for CF in TCSs with higher levels of HADS-Anxiety and HADS-Depression was increased two- to five-fold, respectively.

Conclusions: The increasing prevalence of CF in TCSs is a novel finding. Lifestyle interventions, early detection and treatment of depression and anxiety, and possibly testosterone substitution might reduce the risk of CF. Extended long-term follow-up seems to be important.

Keywords: fatigue; hypogonadism; physical activity; survivorship; testicular cancer; testosterone.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Anxiety / epidemiology*
  • Anxiety / etiology
  • Chronic Disease
  • Comorbidity
  • Depression / epidemiology*
  • Depression / etiology
  • Fatigue / epidemiology*
  • Fatigue / etiology*
  • Follow-Up Studies
  • Humans
  • Logistic Models
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Neoplasm Grading
  • Neoplasm Staging
  • Neoplasms, Germ Cell and Embryonal / complications*
  • Neoplasms, Germ Cell and Embryonal / physiopathology
  • Neoplasms, Germ Cell and Embryonal / therapy
  • Norway / epidemiology
  • Prevalence
  • Prognosis
  • Risk Factors
  • Survivors / statistics & numerical data*
  • Testicular Neoplasms / complications*
  • Testicular Neoplasms / physiopathology
  • Testicular Neoplasms / therapy
  • Testosterone / blood
  • Young Adult


  • Testosterone

Supplementary concepts

  • Testicular Germ Cell Tumor