The psychological wellbeing, health-related quality of life (HRQOL), and supportive care needs of Australian testicular cancer survivors: a quantitative and qualitative investigation

Abstract

Testicular cancer (TC) is one of the most common malignancies in young men aged 15 to 35 years. This thesis provides a comprehensive evaluation of the prevalence, severity, and correlates of psychological distress, impaired HRQOL, and supportive care needs in TC survivors. Men who had completed active treatment for TC 6 months to 5 years previously with no evidence of recurrence were recruited from 14 Australian cancer centers (September 2009 – February 2011). Of 486 eligible TC survivors, 244 (50.2%) completed a self-report questionnaire measuring psychological distress (DASS21), generic HRQOL (SF-36v2), TC-specific HRQOL (EORTC QLQ-TC26), adjustment style (MAC), social support (DUFSS), and unmet needs (CaSUN). A further 24 men completed in-depth interviews. Participating TC survivors reported impairments to several more mental aspects of generic and cancer-specific HRQOL compared with the general population and TC survivors from other countries respectively. The most problematic TC-specific HRQOL issues were similarly more mental than physical. A significantly greater proportion of TC survivors also reported clinical anxiety/depression relative to the general population. It is notable that only certain HRQOL domains were impaired in TC survivors and only a subgroup had clinically relevant psychological morbidity. The number of TC survivors with strong unmet needs was also relatively small; the most prevalent unmet needs related to existential and relationship issues. This highlights the need to identify TC survivors at risk of poorer outcomes and for interventions to target the areas of greatest impairment, rather than routinely offering generic interventions. Men’s subjective perceptions of the impact of TC seem to be more closely related to their HRQOL and psychological wellbeing than objective disease and treatment factors. Men who: are younger, are not well informed about TC, experience job problems, suffer from FCR, have low social support, and are helpless-hopelessness or avoidant copers are at greatest risk of poor outcomes. Some TC survivors may be reluctant to undertake traditional forms of psychological treatment (i.e. face-to-face psychotherapy). Alternative ways of supporting TC survivors (e.g. Internet resources) may be more accessible, cost effective, and less stigmatised.