Table 1.
Clinical and Sociodemographic Characteristics, and Health Behaviors of 1,802 Survivors of Cisplatin-Treated Germ-Cell Tumors (GCT) According to Prescription Medication Use for Anxiety and/or Depression
| Clinical characteristic | Total No. (%) | Use of medications for anxiety and/or depression,r No. (%) | |
|---|---|---|---|
| 1,802 | No (N= 1,651) | Yes (N= 151) | |
| Age at GCT diagnosis, years | |||
| Median (range) | 30 (10–63) | 30 (10–63) | 31 (10–54) |
| <20 | 140 (7.8) | 127 (7.7) | 13 (8.6) |
| 20–29 | 728 (40.4) | 676 (40.9) | 52 (34.4) |
| 30–39 | 580 (32.2) | 536 (32.5) | 44 (29.1) |
| ≥ 40 | 354 (19.6) | 312 (18.9) | 42 (27.8) |
| Age at clinical evaluation, years | |||
| Median (range) | 37 (18–75) | 37 (18–75) | 39 (18–64) |
| <30 | 428 (23.8) | 397 (24.1) | 31 (20.5) |
| 30–39 | 644 (35.7) | 598 (36.2) | 46 (30.5) |
| 40–49 | 429 (23.8) | 388 (23.5) | 41 (27.2) |
| 50–59 | 240 (13.3) | 214 (13.0) | 26 (17.2) |
| ≥ 60 | 61 (3.4) | 54 (3.3) | 7 (4.6) |
| Calendar year of diagnosis a | |||
| Before 2000 | 195 (11.0) | 183 (11.2) | 12 (8.2) |
| 2000–2009 | 609 (34.2) | 552 (33.8) | 57 (38.8) |
| 2010–2017 | 976 (54.8) | 898 (55.0) | 78 (53.1) |
| Histologic type b | |||
| Seminoma | 438 (24.6) | 403 (24.7) | 35 (23.8) |
| Nonseminoma | 1324 (74.4) | 1214 (74.3) | 110 (74.8) |
| GCT, not otherwise specified | 18 (1.0) | 16 (1.0) | 2 (1.4) |
| Site of GCT c | |||
| Testis | 1588 (89.2) | 1461 (89.5) | 127 (86.4) |
| Extragonadal | 192 (10.8) | 172 (10.5) | 20 (13.6) |
| Cisplatin-based chemotherapy d | |||
| BEP e | 1009 (56.3) | 920 (56.1) | 89 (58.4) |
| EP f | 657 (36.7) | 605 (36.9) | 52 (34.4) |
| Other g | 126 (7.0) | 116 (7.1) | 10 (6.6) |
| Cumulative dose of cisplatin, mg/m2 h | |||
| Median (range) | 400 (100–1402.8) | 400 (100–1400) | 400 (100–800) |
| <300 | 123 (6.9) | 110 (6.7) | 13 (8.7) |
| 300 | 643 (36.0) | 596 (36.4) | 47 (31.3) |
| 301–399 | 79 (4.4) | 72 (4.4) | 7 (4.7) |
| 400 | 838 (46.9) | 769 (47.0) | 69 (46.0) |
| >400 | 104 (5.8) | 90 (5.5) | 14 (9.3) |
| Time since completion of chemotherapy, years i | |||
| Median (range) | 3.8 (1–35.1) | 3.8 (1–35.1) | 3.8 (1–29.9) |
| <2 | 553 (31.8) | 511 (32.1) | 42 (28.8) |
| 2-<5 | 464 (26.7) | 422 (26.5) | 42 (28.8) |
| 5-<10 | 355 (20.4) | 327 (20.5) | 28 (19.2) |
| ≥ 10 | 366 (21.1) | 332 (20.9) | 34 (23.3) |
| Sociodemographic characteristic | |||
| Race j | |||
| White | 1484 (87.7) | 1348 (87.2) | 136 (93.2) |
| African American | 18 (1.1) | 16 (1.0) | 2 (1.4) |
| Asian | 77 (4.6) | 73 (4.7) | 4 (2.7) |
| Other | 113 (6.7) | 109 (7.1) | 4 (2.7) |
| Education k | |||
| High school or less | 206 (11.9) | 184 (11.7) | 22 (14.7) |
| After high school but not college graduate | 411 (23.8) | 370 (23.5) | 41 (27.3) |
| College or university graduate | 726 (42.1) | 677 (43.0) | 49 (32.7) |
| Post-graduate | 382 (22.1) | 344 (21.8) | 38 (25.3) |
| Employment status l | |||
| Unemployed | 114 (6.7) | 94 (6.0) | 20 (13.3) |
| Employed | 1526 (89.0) | 1411 (90.2) | 115 (76.7) |
| Retired | 34 (2.0) | 31 (2.0) | 3 (2.0) |
| On disability leave | 40 (2.3) | 28 (1.8) | 12 (8.0) |
| Marital status m | |||
| Single or never married | 569 (33.2) | 527 (33.6) | 42 (29.0) |
| Married/living as married | 1039 (60.6) | 949 (60.5) | 90 (62.1) |
| Divorced/separated | 107 (6.2) | 94 (6.0) | 13 (9.0) |
| Health insurance coverage n | |||
| No | 156 (9.0) | 148 (9.3) | 8 (5.3) |
| Yes | 1580 (91.0) | 1438 (90.7) | 142 (94.7) |
| Health behavior | |||
| Smoking status o | |||
| Never | 995 (57.3) | 922 (58.1) | 73 (48.7) |
| Former | 591 (34.0) | 527 (33.2) | 64 (42.7) |
| Current | 150 (8.6) | 137 (8.6) | 13 (8.7) |
| Average no. alcoholic drinks in past year p | |||
| Rarely or never | 355 (20.5) | 315 (19.9) | 40 (26.5) |
| 1–3 per month | 235 (13.6) | 208 (13.2) | 27 (17.9) |
| 1–6 per week | 807 (46.6) | 750 (47.4) | 57 (37.8) |
| ≥ 1 per day | 336 (19.4) | 309 (19.5) | 27 (17.9) |
| Engage in vigorous physical activity (≥ 6 METs) q | |||
| Yes | 1180 (67.9) | 1098 (69.1) | 82 (55.0) |
| No | 557 (32.1) | 490 (30.9) | 67 (45.0) |
Abbreviations: BEP, bleomycin, etoposide, and cisplatin; EP, etoposide and cisplatin; GCT, germ cell tumor; MET, metabolic equivalent of task; VeIP, vinblastine, ifosfamide, and cisplatin; VIP, etoposide, ifosfamide, and cisplatin.
Calendar year of diagnosis was not available for 22 participants.
Histologic type was not available for 22 participants.
Germ cell tumor site was not available for 22 participants.
Fifty-nine (3.3%), 723 (40.4%), 940 (52.5%), and 68 (3.8%) participants received ≤ two, three, four, and five or more cycles of cisplatin-based chemotherapy, respectively. Chemotherapy regimen and number of cycles was not available for 10 and 12 participants, respectively.
Includes 252 (25.0%) participants with modification of dosing and schedules of BEP. The remaining 757 participants (75%) received the standard dosing and standard BEP schedule: each chemotherapy cycle consisted of bleomycin, 30,000 IU days 1, 8, and 15; etoposide 100 mg/m2 days 1 through 5; and cisplatin 20 mg/m2 days 1 through 5. Median cumulative cisplatin doses for the BEP group were 300 mg/m2 (range, 100 to 900 mg/m2).
Includes 312 (47.5%) participants with modification of dosing and schedules of EP. The remaining 345 participants (52.5%) received the standard dosing and standard EP schedules: each chemotherapy cycle consisted of etoposide 100 mg/m2 days 1 through 5 and cisplatin 20 mg/m2 days 1 through 5. The median cumulative cisplatin doses for the EP group were 400 mg/m2 (range, 110 to 1403 mg/m2).
Of 126 participants, 66 received VIP, 35 received cisplatin and ifosfamide; 9 received cisplatin, bleomycin, etoposide, and ifosfamide; two received VeIP. For the remaining 14, other combinations of cisplatin-based chemotherapy were applied.
Cisplatin dose information was not available for 15 participants.
Information on time since completion of chemotherapy was not available for 64 participants.
Race was not stated for 110 participants.
Educational status was not stated for 77 participants.
Employment status was not stated for 88 participants.
Marital status was not stated for 87 participants.
Health insurance coverage was not stated for 66 participants.
Smoking status was not stated for 66 participants.
Average no. of alcoholic drinks in past year was not stated for 69 participants.
Physical activity was assessed in this study based on a validated questionnaire (21–23). Participants were asked about the type of physical activity (walking; jogging (>10 min/mile); running ≤ 10 min/mile); bicycling; aerobic exercise; lower intensity excursive such as yoga, stretching, and toning; tennis, squash, or racquetball; lap swimming; weight lifting or stretch swimming) and average time per week (during the past year) spent at each of these activities. A MET score was assigned to each physical activity based on its energy cost. Vigorous physical activity was defined based on activities with MET value ≥ 6 (23). Physical activity information was not provided by 65 participants.
Based on self-reported prescription medications taken for at least the past 4 weeks. Medication indication was classified as used for anxiety and/or depression according to both (1) its pharmacological class (31,32) and (2) if patients indicated its use was for anxiety and/or depression. Participants could report use of more than one medication for anxiety and/or depression. Medications used by 151 participants include alprazolam (n=15), amitriptyline (n=2), bupropion (n=10), buspirone (n=3), citalopram (n=15), clomipramine (n=2), clonazepam (n=24), desvenlafaxine (n=1), duloxetine (n=9), escitalopram (n=29), fluoxetine (n=11), fluvoxamine (n=1), imipramine (n=1), lorazepam (n=8), mirtazapine (n=1), nortriptyline (n=1), paroxetine (n=13), sertraline (n=20), trazodone (n=6), and venlafaxine (n=13).