Given the available curative treatments for testicular cancer, a thorough understanding of psychosocial outcomes, such as QOL, among patients and survivors is essential. QOL is a multidimensional concept that reflects an individual's perception of well-being. QOL measurement typically incorporates the influence of functioning domains such as physical, psychological, and social health.15 Frequently, QOL is conceptualized as existing on a continuum, with disease onset and symptom status representing variables proximal to disease onset, and with overall (or generic) QOL as a more distal variable (Figure 24-1). An important component of this model is the distinction between disease and/or treatment-specific functioning and overall functioning. For example, the model would predict that cancer treatment would first cause treatment-related side effects (eg, gonadal toxicity). Subsequently, these side effects would adversely affect specific domains of functioning (eg, reduced fertility). Finally, reduced functional ability would lead to a reduction in overall QOL. External variables, such as personal and environmental characteristics, may exert influence throughout this continuum, further influencing QOL.16-18 The model's structure is useful in understanding the many factors that contribute to QOL outcomes.
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