Cancer
Air pollution is associated with cardiovascular and respiratory healthcare encounters among testicular cancer survivors Judy Ou* Judy Ou Joemy M Ramsay Heydon K Kaddas Jim VanDerslice Brock O Neil Sarah M Garcia Heidi Hanson Anne Kirchhoff
Aim: Chemotherapy for testicular cancer is highly effective but contributes to long-term risks for heart and lung problems. Air pollution leads to and worsens heart and lung conditions, but its impact on the health of testicular cancer survivors is unknown. We assessed associations between exposure to nitrogen dioxide (NO2) and ozone (O3) and health events with a cardiovascular or respiratory diagnosis among survivors of adolescent and young adult (AYA) testicular cancer.
Methods: This Utah-based case-crossover study included 385 survivors, diagnosed 2000-2016 at age 15-39 years and living 2 years after diagnosis, who had emergency department/urgent care [ED/UC] or inpatient admissions with a cardiovascular (nevent=257) and/or respiratory (nevent=685) diagnosis. Conditional logistic regression with robust standard errors estimated associations while controlling for temperature and humidity. Continuous and dichotomous (≥moderate Air Quality Index (AQI)) measures were included for NO2 and O3 for the 1-4 days before events (lag days). We conducted subgroup analysis according to cancer treatments.
Results: Exposure to NO2 ≥moderate AQI on lag day 1 increased odds for any cardiovascular event (OR=1.97, 95% CI=1.08-3.59) and cardiovascular inpatient admission (OR=2.48, 95% CI=1.21-5.10). Survivors treated with chemotherapy and exposed to NO2 ≥moderate AQI on lag day 1 had increased odds for cardiovascular inpatient admission (OR=3.00, 95% CI=1.29-7.00). O3 ≥moderate AQI on lag day 4 also increased odds for respiratory ED/UC visit (OR=1.34, 95% CI=1.00-1.79). O3 on lag day 4 was associated with any cardiovascular event (OR=1.02/1-ppb, 95% CI=1.00-1.03) and cardiovascular inpatient admission (OR=1.03/1-ppb, 95% CI=1.00-1.05).
Conclusions: Air pollution may worsen long-term outcomes among AYA testicular cancer survivors. This information can improve survivorship care plan for testicular cancer by addressing air pollution as a risk factor for exacerbation of these conditions.