Hearing loss afflicts cancer survivors regardless of type of chemotherapy

Hearing difficulties, including clinically significant hearing loss, have been reported in adult cancer survivors receiving platinum- or taxane-containing therapy, researchers report.

In a cross-sectional study of more than 200 breast, gastrointestinal, gynecological or lung cancer survivors, more than half had audiogram-proven of hearing loss, while up to 45% report clinically meaningful levels of tinnitus, University of California, San Francisco (UCSF) and colleagues.

In addition, whether patients received a platinum-based regimen, a taxane-based regimen, or combination two, they said in BMJ Supportive & Palliative Care.

“It is clear in the literature, and already supported by preclinical studies, that platinum compounds are ototoxic,” Miaskowski told MedPage Today . “Equally important in this study is that the taxanes known to produce chemotherapy-induced peripheral neuropathy also contribute to hearing loss and tinnitus.”

Miaskowski also noted that while Hearing loss and platinum drug use were reported in adults with testicular and head and neck cancers, and this study shows for the first time that hearing loss and tinnitus are very common problems among survivors of the four most common forms of cancer.

The good news, she added, is that “the range of hearing loss caused by these compounds can be used with hearing aids.” Only 17 percent of the survivors in the study sample used hearing aids.

“If we can get information that people should be highly suspicious [about potential hearing loss], we can make a difference because it can be treated with hearing aids,” Miaskowski said.

The mean age of the cancer survivors in the study was 61 years and the Karnofsky performance status score was higher than 50. They were willing to complete a self-report questionnaire and receive a 3-hour study visit that included a hearing test . The median time since cancer diagnosis was 3.9 to 6.2 years, depending on the chemotherapy regimen received.

The authors found that 12.8% of the 273 survivors received a platinum-containing regimen, 56.8% were a taxane-containing regimen, and the remaining 30.4% were a combination of both. The majority of patients in the taxane-only group had breast cancer (95.5%), while 68.6% in the platinum-only group had gastrointestinal cancer. More than half (51.8%) of patients treated with the two compounds developed breast cancer.

The three chemotherapy groups found no differences in the incidence of self-reported hearing loss before the study visit. In the chemotherapy group, the incidence of self-reported hearing loss ranged from 30.5% (platinum and taxane) to 34.3% (platinum only).

Study survivors were classified as audiographically confirmed if their age and sex scores were below the 50th percentile at any frequency.

The authors report that there were no statistically significant differences in the incidence of audiogram-confirmed hearing loss among the three chemotherapy groups either. However, these rates were significantly higher than the self-reported rates, ranging from 52.3% (taxane only) to 71.4% (platinum only).

Of the total sample, 25.4% self-reported audiogram-confirmed hearing loss, 31.0% self-reported they had no audiogram-detected hearing loss, and 7.4% self-reported audiogram-confirmed hearing loss For unconfirmed hearing loss, 36.2% self-reported that they had no hearing loss and no hearing loss was found on the audiogram.

“The prevalence of hearing loss among survivors is very, very high,” Myaskovsky said. Given that a large proportion of patients underestimate their hearing loss, and that few of them use hearing aids, the message to oncologists is “simple,” she said. “Ask the patient if they have symptoms. They need an audiogram because people don’t think their hearing loss is that bad.”

In the case of tinnitus, if survivors report that they They were classified as having tinnitus when they were consciously aware of tinnitus for more than 10% of their waking hours. There was no difference in the incidence of tinnitus among the three chemotherapy groups, ranging from 40.3% (taxane only) to 45.7% (platinum only) and 37.1% (platinum) to 40.0% (taxane) before the study visit visit back.

Study limitations included the fact that the sample was predominantly female and white, so “the findings may not generalize to all cancer survivors,” the authors noted.

“Future studies are needed to evaluate hearing loss and tinnitus throughout cancer treatment,” they stress. “Our findings suggest that common underlying mechanisms of hearing loss and tinnitus merit evaluation in preclinical and clinical studies.”

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  Mike Bassett is an oncology specialist and a staff writer for Hematology. He lives in Massachusetts.

Disclosure

This study was funded by the National Cancer Institute, the American Cancer Society (ACS), and the National Center for the Advancement of Translational Science/NIH/UCSF-Institute of Clinical and Translational Science. Research recruitment was supported by the Love Research Army of Dr. Susan Love Foundation.

Miaskowski has revealed that he is a professor of clinical research at ACS.