Acute subjective morbidity after cisplatin-based combination chemotherapy in patients with testicular cancer: a prospective study.

In a randomized trial, 22 patients with metastatic testicular cancer used low-fibre diet during and after their first cycle of cisplatin and vinblastine containing combination chemotherapy, in order to reduce the acute gastrointestinal post-treatment morbidity (Group 1). Their subjective morbidity, including aspects of general well-being, was compared to 23 comparable patients having no diet restrictions (Group 2). A third similarly composed group consisted of 10 testicular cancer patients without diet restrictions, who received etoposide (VP-16) instead of vinblastine. Low-fibre diet did not reduce the frequency or severity of the acute post-treatment gastrointestinal morbidity. Severe constipation and/or paralytic ileus was observed in 23 patients in Groups 1 and 2 and necessitated short-term hospitalization in 14. The substitution of vinblastine by etoposide resulted in a significant reduction of the acute gastrointestinal morbidity and in a considerable improvement of the patients' general well-being. It is concluded that VP-16 should be given instead of vinblastine to patients receiving cisplatin-based combination chemotherapy in order to maintain an optimal quality of life during cytostatic treatment. This study also indicates that the frequency and severity of subjective treatment-related morbidity often is underestimated by retrospective routine clinical assessment, and should preferably be assessed prospectively by frequently applied patients' questionnaires.