Testicular cancer: overview and implications for health care providers.

Testicular cancer is the most common cancer in young men 15 to 35 years of age. This diagnosis, while devastating to the young man has, with aggressive treatment, the potential of a cure. This article will focus on the symptoms, the diagnosis, and the treatment of testicular cancer. In addition to nursing care during those stages, the nursing implications in educating those at risk along with early detection of this cancer will be the considered in this article.

Barriers and facilitators for oncology nurses discussing sexual issues with men diagnosed with testicular cancer.

PURPOSE: Testicular cancer occurs at a time in a man's life when major social life changes are occurring and when body image, fertility, sexual desire and performance can be central issues. Oncology nurses, as members of the multidisciplinary team, are in an ideal position to address men's concerns. The aim of this study was to investigate oncology nurses' self-perceived knowledge and comfort in relation to discussing sexuality concerns with men diagnosed with testicular cancer and to identify the barriers and facilitators to such discussions. METHODS: This study employed a self-completion, anonymous survey design with a sample of registered nurses working in five, randomly chosen, oncology centres in Ireland. RESULTS: In total, 89 questionnaires (45% response rate) were included for analysis. Findings suggest that although nurses were open to addressing concerns, few informed patients they were available to discuss sexual concerns. Nurses reported lacking knowledge of, and discomfort in, discussing the more intimate aspects of sexuality, including: ejaculatory difficulties, erectile dysfunction, impotence, prosthesis options and testicular self examination. CONCLUSIONS: Findings reinforce the need for more comprehensive education on sexuality issues and testicular cancer. Nurses need to take a more proactive approach to sexuality care, as opposed to the 'passive waiting stance' that permeates the current culture of care. Education programmes need to include specific information on sexual issues associated with testicular cancer, and oncology nurses must subsume sexuality as an essential aspect of their role through changes in policies and nursing care planning.

Development and qualitative evaluation of a self-management workshop for testicular cancer survivor-initiated follow-up.

PURPOSE/OBJECTIVES: To describe the needs of testicular cancer survivors, develop a nurse-led workshop, and explore the experience of participation. RESEARCH APPROACH: A systematic intervention development process was used to design a self-management workshop for cancer survivors, which then was evaluated qualitatively. SETTING: Outpatient clinic in England. PARTICIPANTS: 26 healthcare professionals, charity workers, family members, and testicular cancer survivors participated in the intervention development process. Six testicular cancer survivors attended the workshop and participated in the postintervention focus group discussion. METHODOLOGIC APPROACH: Ten participants, including four survivors, completed the initial needs assessment interviews. Twenty-six participants then rated the identified needs on two dimensions: importance to self-management and changeability via a self-management intervention. Literature review and expert consultation were used to identify potential workshop components. To explore the experience of attending the intervention, six testicular cancer survivors who participated in the nurse-led workshop were interviewed six weeks later. FINDINGS: The workshop was well received by participants, who appreciated the goal-setting and information provision activities. The men also felt that they had benefited from the experience of being in the group. CONCLUSIONS: Testicular cancer survivors had unmet post-treatment needs. The systematic intervention development method led to an evidence-based workshop to address those needs. Men reported benefits from attending the workshop, which may help maintain and improve health. INTERPRETATION: Nurse-led workshops can address the current unmet needs of testicular cancer survivors. KNOWLEDGE TRANSLATION: Testicular cancer survivors may require support with health information, maintaining psychological health, and monitoring cancer symptoms. Survivors also need help planning and maintaining an active lifestyle. In addition, a brief workshop approach to intervention delivery is acceptable to testicular cancer survivors.

Testicular cancer.

OBJECTIVES: To discuss the presentation, diagnosis, chemotherapy, surgical options, nursing management, and long-term outcomes of patients with testicular cancer. DATA SOURCES: Review and research articles, clinical experience. CONCLUSION: Testicular cancer is very treatable and the cure rate is approximately 95%. It is most common in men between the ages of 15 and 35. While early detection, diagnosis, and treatment are all important factors for treating the disease, fertility and quality of life are also important issues to address in patients with testicular cancer. IMPLICATION FOR NURSING PRACTICE: Nurses must provide patient instruction regarding chemotherapy, surgery, fertility, and side effects of treatment. Serving as a patient advocate regarding fertility preservation and promoting quality of life are important factors for health professionals to consider.

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Cardiovascular risk in testicular cancer survivors treated with chemotherapy: incidence, significance, and practice implications.

PURPOSE/OBJECTIVES: To explore what is known regarding cardiovascular late effects of treatment, such as Raynaud phenomenon, hypertension, hyperlipidemia, and coronary artery disease as well as the risk for cardiovascular events experienced by patients with testicular cancer treated with chemotherapy. DATA SOURCES: Literature review of treatment options and cardiovascular risk in patients with testicular cancer from PubMed, MEDLINE, oncology nursing literature, and the Internet. DATA SYNTHESIS: Evidence exists that chemotherapy used to treat testicular cancer may increase risk of cardiovascular disease. More research is needed to clarify the risks further. Patients and their healthcare providers must be aware of the potential toxicities. CONCLUSIONS: A limited but growing body of research is focused on defining cardiovascular risks in this population. IMPLICATIONS FOR NURSING: Nurses have an important role in exploring and identifying cardiovascular risk factors in patients, furthering research to clarify the risks, and using the knowledge to improve patient care and education.

Barriers identified by Swedish school nurses in giving information about testicular cancer and testicular self-examination to adolescent males.

The purpose of this study was to investigate to what extent school nurses in Sweden inform adolescent men about testicular cancer (TC) and testicular self-examination (TSE). A questionnaire was completed by 129 school nurses from 29 randomly selected municipalities. All respondents were women, with a mean age of 42 years. The results showed that about 6% of the school nurses had provided information on TC and 9% on TSE; however, the majority was open to presenting such information. The major reason reported for not providing this guidance was insufficient knowledge about the subject. The nurses who had given information were knowledgeable about both TC and TSE and more often informed young men about TC and TSE, whereas those who had only received information about TC were not as likely to provide information about TC or TSE. The results of this study highlight the need to educate school nurses about TC and TSE so they can include this information in their health teaching to adolescent males.

Surgical management of testicular cancer.

Surgery is an integral component in the management of testicular cancer. Prior to the advent of cisplatin chemotherapy, a retroperitoneal lymph node dissection (RPLND) was the only chance for cure of testicular cancer. Over the years, the surgical techniques have been improved greatly to decrease the occurrence of complications (e.g., incidence of retrograde ejaculation). Currently, RPLND can be done as the initial therapy or after chemotherapy. In either situation, the postoperative management of patients with testicular cancer can be complicated and requires thorough, ongoing assessment. This article presents the surgical indications for RPLND and the nursing management.

Self-perceived physical, psychologic, and general symptoms in survivors of testicular cancer 3 to 13 years after treatment.

Due to the large group of patients with advanced testicular cancer now being cured, it is important to identify the men who are at risk of deteriorated health. The purposes of this study were: (1) to delineate and compare frequency of self-perceived physical, psychologic, and general symptoms in men treated for testicular cancer with those of a general population sample and (2) to compare self-perceived physical, psychologic, and general symptoms in relation to secondary Raynaud phenomena, sexual dysfunction, infertility, and self-perceived attractiveness in different treatment modalities. The subjects were 277 survivors of testicular cancer (M = 42.2 years) who had completed a self-reported questionnaire (75.5% response rate). A population survey comprising 392 men was used as a comparison group (M = 45 years). The result demonstrated that although survivors of testicular cancer as a group reported significantly less frequency of backache, leg pain, cough, and eye problems than did the general population sample, they described that they significantly more often felt cold. Men reporting secondary Raynaud phenomena, infertility, and/or feeling less attractive had experienced significantly more self-perceived symptoms. Oncologist nurses could play an important role in psychologic counseling for those men.

An interview study of men discovering testicular cancer.

Testicular cancer affects men between 15 and 45 years old. The aim of this study was to show how men with testicular cancer discover their cancer, react to physical changes, and take action. In the follow-up phase, 21 who had undergone surgery for testicular cancer were interviewed. The results show clearly that the men focus on their physical pain. The progress from the discovery of changes in the testicular glands to medical care can be divided into three phases. In the first phase, "something has happened," the men consider the changes and try to define the reasons. In the second phase, "facing the situation," they consider the situation and decide whether to talk to someone. In the third phase, "seeking medical help," it is a question of seeking help and being confronted by the medical diagnosis. In terms of time, the progression in the current study took from 1 day to 1 year. The men sought help when complications arose that made normal daily functions difficult. Six of the men suspected that the cause of their problems was cancer. Almost half of the participants in this study, including the six who suspected cancer, did not talk to anyone before they decided to seek medical help. The men who did talk to other people did not seek medical help any more quickly than the other men. None of the men routinely inspected their bodies.

Teaching and promoting testicular self-examination.

Testicular cancer is the commonest malignancy of young men, but it also has a high cure rate. This article discusses the teaching and promotion of testicular self-examination as a technique for early detection of the disease.

Practice development in cancer care: self-help for men with testicular cancer.

This article describes a joint initiative between health professionals and men who had had testicular cancer to set up a self-help group. The aims of this group were, and still are, to provide information and support and to instigate professional education.

Attendance at cancer follow-up clinic: does it increase anxiety or provide reassurance for men successfully treated for testicular cancer?

This cross-sectional descriptive study examined the meaning of the cancer follow-up clinic for men who have been successfully treated for testicular cancer. The sample of 62 men were selected using a nonprobability quota sampling method before attendance at a routine testicular cancer follow-up clinic within the Directorate of Clinical Oncology, Western General Hospitals NHS Trust, Edinburgh, Scotland. Subjects were given four instruments to complete immediately before seeing the doctor in the clinic, and two instruments to complete on day 8 after the clinic appointment. Instruments included the State-Trait Anxiety Inventory (STAI), a demographic questionnaire, and two Likert scales adapted for use in the study: the Common Concerns about Testicular Cancer questionnaire and the Psychological Consequences of Screening questionnaire (PCQ). Results demonstrated that men attending the clinic exhibit low levels of anxiety at the points measured, but gain a great deal of reassurance from the clinic visit. Results also demonstrated the areas of concern about testicular cancer and its management that influence anxiety in the follow-up clinic.