Psychological aspects of testicular cancer.

The “quality of life” issue in these young patients during and after treatment takes on new importance and requires clinical concern by all physicians who treat germ cell tumors.

Abstract

T ESTICULAR CANCER, which occurs in men primarily between the ages of 20 and 40 when sexual activity is at a peak, carries with it not only the psychologic meaning of a significant threat to life but to sexual potency and masculinity as well. The emotional impact of this cancer has received suprisingly little attention despite the fact that these tumors are the second leading cause of cancer-related deaths for males between the ages of 15 and 34.’ Since recent advances in the treatment of germ cell tumors have markedly improved cure rates and the overall duration of survival, it is imperative for physicians to direct their attention to the early and late psychological adaptation of these young men. Initially, full participation in the treatment regimens requires a high level of commitment and cooperation by the patient. Failure to adhere to therapy because of phsychological stress related to cancer or chemotherapeutically-induced toxic side effects may compromise cure or long-term survival. When appropriate emotional adjustment is achieved during illness, men who survive longer or who are cured should have fewer adverse psychologic sequellae from the experience. Thus, the “quality of life” issue in these young patients during and after treatment takes on new importance and requires clinical concern by all physicians who treat germ cell tumors. Several reports have dealt specifically with infertility resulting from autonomic injury during bilateral retroperitoneal lymphadenectomy. The emotional concerns and sexual fears that are often embarrassing for patients to bring to their doctor’s attention are suffered, at times, in silence. The busy physician may also worry that if he opens the door to a discussion of emotional issues, a time-consuming Pandora’s Box of problems may erupt that is better left to another time. Such concerns on both sides may impede the doctor-patient interaction in an important area where an empathic physician can appreciably add to the patient’s comfort by a more open discussion of his emotional and sexual concerns. Attention to common psychological problems engendered at the time of diagnosis and at each stage of treatment can prevent