Survivorship care after testicular cancer: New insights in late effects of treatment and approaches to shared-care follow-up

Testicular cancer is the most common type of cancer among men between the ages of 20 and 40. Thanks to the success of platinum-based chemotherapy most patients can be cured. However, this success comes at a price. Testicular cancer survivors are at risk for toxic side effects, such as cardiovascular disease. These side effects can occur during chemotherapy, but also years afterwards. The studies described in this thesis, aim to improve our understanding of the mechanisms of treatment-related morbidity in testicular cancer patients and to develop and evaluate a new model for shared-care survivorship care after testicular cancer. The focus of the first part of this dissertation lies on the etiology of cardiovascular late toxicity in testicular cancer survivors. Platinum remains detectable up to twenty years after chemotherapy. In one study the relationship between long-term circulating platinum levels and known late effects was determined. In another study the relationship between genetic variations in androgen metabolism and late effects was investigated. The first part concludes with a study in which a risk model is developed to identify patients that are at risk for cardiovascular events during and shortly after chemotherapy. The second part focuses on the organization of survivorship care of testicular cancer patients. During shared-care follow-up the oncologist collaborates with the primary care provider. A clear follow-up plan is an essential part. A shared-care survivorship care program for testicular cancer survivors was developed and evaluated. It was concluded that shared-care follow-up is a safe and feasible alternative for hospital-only follow-up