Validation of the Testicular Health Outcomes Report (THOR): a testicular cancer health-related quality of life instrument.

OBJECTIVE

To evaluate the psychometric properties of the Testicular Health Outcomes Report (THOR) tool by assessing associations of disease burden and treatment received with health-related quality of life (HRQoL) domains.

MATERIALS AND

METHODS

THOR, which comprises 26 questions across 14 HRQoL domains, was administered electronically to patients presenting for known or suspected testicular cancer prior to clinical visits and throughout their care longitudinally. We evaluated construct validity by determining whether related constructs showed better correlation with disease and treatment burden than unrelated constructs. Generalised estimating equations were used for each domain or predictor of interest.

RESULTS

Between August 2022 and November 2024, 709 patients completed 906 surveys. More aggressive post-orchiectomy treatment - such as retroperitoneal lymph node dissection (RPLND), chemotherapy or post-chemotherapy RPLND - was associated with worse sexual function and problems with job/education. Patients undergoing nerve-sparing RPLND reported significantly better sexual function (22 points, 95% confidence interval 11, 33; P < 0.001) as compared to a non-nerve-sparing RPLND approach. Receipt of chemotherapy was associated with lower fertility confidence vs surveillance or primary RPLND (P = 0.005). Psychosocial domain scores and concern about disease relapse improved with time (P < 0.001). However, concern about relapse was not associated with initial clinical stage.

CONCLUSIONS

The THOR survey instrument is a valid measure of symptom burden and treatment received in men with testicular cancer.