Surveillance of patients with complete response following first-line chemotherapy for germ cell tumors: Focus on lifestyle, socioeconomic, and sexual health outcomes.

Abstract

608 Background: Advances in multimodal therapy have transformed germ cell tumors (GCTs) into a highly curable malignancy, creating a growing population of long-term survivors. This shift demands that surveillance evolve beyond disease monitoring to address broader survivorship challenges. Social reintegration, employment, marital status, and sexual function profoundly influence quality of life but remain under-explored in GCT follow-up care. Understanding these domains is essential for developing comprehensive survivorship strategies. Our study evaluates long-term social, lifestyle, and sexual health outcomes among GCT survivors who achieved complete response (CR) after first-line chemotherapy, and to identify key challenges revealed through surveillance follow-up. Methods: A cross-sectional study was conducted in 66 GCT patients treated between 2010 and 2019 who achieved CR and were followed under standard surveillance protocols. Progression-free survival (PFS) and overall survival (OS) were estimated using Kaplan–Meier methods. Structured interviews and validated questionnaires, including the International Index of Erectile Function-5 (IIEF-5), evaluated lifestyle behaviors, socioeconomic outcomes, and sexual function. Results: Among 66 patients, after a median follow-up of 14.43 years, the mean age at diagnosis was 20.2 years (range 7–52). Primary sites were testis (21%), extragonadal mediastinal/retroperitoneal (16%), and central nervous system (62%). IGCCCG risk classification was favorable in 15.2%, intermediate in 60.6%, and poor in 24.2%. All patients received chemotherapy, and 65% also received radiotherapy. Disease recurrence occurred in 15.1%. The 5- and 10-year disease-free survival rates were 89.4% and 85.5%, respectively, with overall survival of 100%. One patient developed secondary papillary thyroid carcinoma. Overweight and obesity increased from 16.4% at diagnosis to 38.8%. Smoking and alcohol use were reported by 16.6% and 10.6%, respectively. Social outcomes revealed persistent challenges: 25.8% were unemployed, 93.9% remained unmarried, and only 1.53% had children. Sexual function assessment showed 73% had no dysfunction, 23% mild, and one mild-to-moderate dysfunction. Conclusions: Surveillance of GCT survivors reveals that while long-term survival is excellent, significant social and sexual health challenges persist, including high rates of unemployment, low rates of marriage and parenthood, and erectile dysfunction. These findings underscore the need to expand surveillance beyond oncologic endpoints to include targeted interventions for social reintegration, sexual health, and quality-of-life support in survivorship care. Clinical trial information: COA. MURA2024/516.