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Testicular Cancer And Psychological Distress

Testicular Cancer And Psychological Distress

In 2020, testicular cancer (TC) affected 74,458 men, representing 0.4% of global cancer cases. Predominant among young men of European descent, TC’s primary treatment involves orchiectomy, boasting a substantial 95% 5-year survival rate. 

However, the aftermath includes enduring psychological distress, with 20% of men grappling with emotional challenges even a decade post-cancer, leading to heightened use of mental health services. Furthermore, fear of cancer recurrence (FCR) impacts approximately one in three TC patients, affecting their overall quality of life. 

The intricate interplay of contributing factors, such as relationship status, age, sexual dysfunction, unemployment, and coping strategies, influences the mental health landscape in testicular cancer. The research delves into the complexities of gender socialization and masculinities, acknowledging the nuanced impact on the testicular cancer experience.

Adherence to traditional norms, known as gender role conflict, correlates with lower emotional expression and psychological distress in men with cancer. Surprisingly, some traditional masculine norms may protect health behaviors, challenging the belief that strict adherence to all traditional norms is detrimental. 

Recognizing the importance of understanding men’s internal beliefs within the testicular cancer context is crucial for providing gender-sensitive care and enhancing overall quality of life. A nuanced approach to measuring masculinities, acknowledging both protective and maladaptive norms, is imperative. Coping styles and psychological flexibility, influenced by masculinities, play a pivotal role in managing psychological distress, offering potential avenues for intervention.

The Study 

Psychological distress is prevalent among men diagnosed with testicular cancer (TC), and the role of masculinities in explaining this phenomenon is under investigation. 

The study aims to draw comparisons between masculinities and distress in both testicular cancer and healthy control (HC) populations. Furthermore, it seeks to explore the relationships between distress correlates, such as psychological flexibility and coping style, and masculinities within the testicular cancer context.


This study employed a cross-sectional, case-control design with eligibility criteria focused on men aged 18–50 years, possessing the ability to read and write in English, and currently residing in Australia. For individuals with testicular cancer (TC), eligibility requires a diagnosis within the last 10 years and the absence of other chronic health conditions. Healthy controls (HC) needed to have no history of chronic illness. 

Recruitment for men with TC primarily occurred through oncologists and retrospective chart reviews at two specified sites, while HC men were recruited via social media. Data collection took place from August 2021 to April 2023. The study received approval from the PMCC Human Research and Ethics Committee (HREC/72047/PMCC). Prior power analyses indicated that 85 men in each group would provide an 80% ability to detect small-moderate group differences (Cohen’s f2=0.0625) and a moderate association (r=0.30) between constructs in men with TC. Additional details can be found in Supporting Information S2.

Sociodemographic and cancer-related information (TC) were gathered from the participants. Internal consistency for all measures demonstrated good reliability (Cronbach’s αs ≥ 0.80). Regarding masculinities, three scales assessed these constructs: (1) gender role conflict-short form (GRC-SF), (2) the jointly developed Inventory of Subjective Masculinity Experiences (ISME) & Subjective Masculinity Stress Scale (SMSS), and (3) Masculinity in Chronic Disease Inventory (MCD-I; exclusive to TC). ISME scores were derived by coding participant open-text responses (“As a man…”) to 23 dimensions within the coding manual. 

Two independent coders performed this task for both populations, with a third coder resolving conflicts. Psychological distress was measured using (1) Patient-Reported Outcomes Measurement Information System (PROMIS) Anxiety & Depression and (2) Fear of Cancer Recurrence Inventory-Short Form (FCRI-SF; exclusive to TC). Psychosocial correlates (TC only) included coping styles measured by Mini-Mental Adjustment to Cancer (Mini-MAC) and psychological flexibility measured by the comprehensive assessment of acceptance and commitment therapy (CompACT)

The detailed data analysis process, involving R v4.3.1, encompassed effect sizes, p-values, outlier checks, and assessments of non-normality and multicollinearity. Primary aims were addressed using multiple linear regressions, with each measure as an outcome, group (TC vs. HC) as the focal predictor and nine specified covariates.

An additional analysis utilized one-sample t-tests to compare mean T-scores of HC and TC populations against normative PROMIS data from Australian adults (aged ≥18 years) in 2014. Secondary aims were analyzed through Pearson correlations and multiple linear regressions in men with TC, adjusting for a priori specified covariates (TC treatment including RPLND [yes/no] and chemotherapy [yes/no], relationship status, and current psychological treatment).


No disparities were observed in masculinities or psychological distress between the populations, with all p-values exceeding 0.05 and Cohen’s d-values remaining below 0.20, except for subjective masculine stress and restrictive affectionate behavior among men. In the case of individuals with testicular cancer (TC), factors such as restrictive affection/emotion, conflicts between family and work, and subjective masculine stress exhibited associations with psychological distress (correlation coefficients ranging from 0.21 to 0.58). 

Additionally, optimistic action showed a negative association with depression/anxiety and helplessness/hopelessness coping (correlation coefficients ranging from -0.27 to -0.42) and a positive association with psychological flexibility (correlation coefficient of 0.35).

Limitations of the Study 

While the sample demonstrated a degree of diversity, it predominantly consisted of Caucasian/European men, with a mean age of 34 years and a median time since diagnosis of approximately 3 years. This composition may limit the generalizability of the findings to all men with testicular cancer (TC). 

The cross-sectional design employed in the study prevents the establishment of causality and temporal order. Although we included men at various times since diagnosis, the absence of sufficient numbers at specific time points hinders a nuanced understanding of when distress is most prevalent, despite documented long-term mental health impacts.

Additionally, the study incorporated several measurements of masculinities; however, there are inherent limitations. While the Inventory of Subjective Masculinity Experiences (ISME) offers a comprehensive, subjective insight into masculine experiences, certain concepts were not captured. 

For instance, notions such as ‘I am allowed to have weak moments’ and ‘I seek help when needed’ were coded as ‘Other’ due to the current coding manuals lacking dedicated dimensions for these concepts. 

Lastly, although the Patient-Reported Outcomes Measurement Information System (PROMIS) captured some externalizing symptoms like anger, the results of psychological distress may be influenced by the limited measurement of other externalizing symptoms in depression (e.g., risk-taking) and somatic symptoms for anxiety (e.g., nausea), which are more commonly reported by young men.

Final Thoughts 

This research paper helps us understand the complex relationship between psychological distress and masculinities in people with testicular cancer (TC). Even though there were no significant differences between healthy controls (HC) and people with testicular cancer, the results showed that about half of men with testicular cancer had at least mild levels of depression and anxiety. This finding highlights the psychological challenges that come with a TC diagnosis.

This study looked into the factors that contribute to psychological distress in men with v. The study found a link between gender role conflict and subjective masculine stress. These findings shed light on the complex relationship between societal expectations of masculinity and the psychological well-being of people facing the challenges of testicular cancer. Recognizing these connections can help us develop more tailored and effective approaches to supporting the mental health of men in this particular context.

The study suggests that prioritizing certain aspects can be pivotal. Specifically, fostering optimistic action and encouraging psychological flexibility emerges as key focal points. By promoting a mindset that embraces optimism and adaptable masculine values, interventions can potentially mitigate emotional avoidance and facilitate a more resilient psychological outlook for men navigating the complexities of testicular cancer. These insights contribute to the ongoing dialogue on tailored support and intervention strategies that address the unique psychological needs of individuals within the TC population.

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