Testicular cancer survivors face a higher risk of cardiovascular disease due to platinum-based chemotherapy, with approximately one in five developing metabolic syndrome, significantly contributing to long-term mortality.
Memorial Sloan Kettering Cancer Centre in New York City has taken action to address this issue, recognizing the growing need for metabolic screening in routine oncology care.
Metabolic Screening in Oncology Care
According to Ms Maryann Carousso, a nurse practitioner at MSK’s Sidney Kimmel Centre for Prostate and Urologic Cancers, “most men with testicular cancer, even those with advanced disease, are cured, but with that success comes a new challenge, as many survivors go on to develop metabolic syndrome, impacting not just lifespan, but health span.”
Ms Carousso noted that metabolic screening is not consistently integrated into routine oncology care, and at MSK, approximately 50 to 60 men receive outpatient chemotherapy each year, creating an opportunity to integrate structured metabolic screening into routine care.
The clinical problem at MSK was a lack of a standardized process for metabolic syndrome screening, resulting in missed opportunities for early risk identification and intervention, which led to the introduction of a structured, standardized metabolic screening process.
Standardized Metabolic Screening Process
Patients undergo baseline screening on day one of the first chemotherapy cycle, with metabolic measures recorded, including anthropometrics with waist circumference, fasting metabolic laboratory results, and morning testosterone.
Patients are then followed at regular intervals after treatment, with management guided by risk level, ie, the number of metabolic syndrome criteria met, and for patients at low risk, management focuses on lifestyle modification, including weight management, regular physical activity, and a heart-healthy Mediterranean-style diet with annual re-screening.
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For those at moderate risk, lifestyle interventions are intensified, and targeted referrals are considered, which may include nutritional support, primary care or cardiology for hypertension or dyslipidaemia, endocrinology for raised glucose, and men’s sexual health for low testosterone.
Re-screening is recommended within six to 12 months, and patients with three or more criteria meet the definition of metabolic syndrome and require more intensive management, including treatment of identified risk factors, consideration of pharmacologic therapy, and closer follow-up typically at six months.
Early Screening Results
To date, 31 patients have been screened, with most being low risk, but about 16 per cent identified as moderate to high risk, highlighting the value of early screening, and several of these patients required initiation of antihypertensive and/or lipid-lowering therapy.
Ms Carousso concluded that their experience demonstrates that metabolic screening is feasible within routine oncology care and supports early risk-based intervention, and this approach is scalable and has the potential to be applied more broadly across oncology populations.
By integrating metabolic screening into routine care, healthcare providers can help identify patients at risk of cardiovascular disease and provide targeted interventions to improve their health outcomes, which is particularly important for testicular cancer survivors who are already at a higher risk of developing metabolic syndrome.
The implementation of this standardized metabolic screening process at MSK serves as a model for other healthcare institutions to follow, and its success highlights the importance of addressing cardiovascular risk in testicular cancer survivors, which can have a significant impact on their long-term health and well-being.
They are making progress.
