Hearing Loss Plagues Cancer Survivors No Matter the Type of Chemo

Hearing difficulties, including clinically meaningful hearing loss, occurred among adult cancer survivors who had either platinum- or taxane-containing regimens, researchers reported.

In the cross-sectional study of more than 200 survivors of breast, gastrointestinal, gynecologic, or lung cancers, more than half had audiogram-confirmed hearing loss, while up to 45% reported clinically meaningful levels of tinnitus, according to Christine Miaskowski, RN, PhD, of the University of California San Francisco (UCSF), and colleagues.

Furthermore, these rates were similar no matter whether patients were treated with platinum regimens, taxane regimens, or a combination of the two, they stated in BMJ Supportive & Palliative Care.

“It has been pretty clear in the literature, and has been supported by preclinical studies, that platinum compounds produce ototoxicity,” Miaskowski told MedPage Today. “What was equally important in this study was that taxanes, which are known to produce chemotherapy-induced peripheral neuropathy, also caused hearing loss and tinnitus.”

Miaskowski also noted that while an association between hearing loss and the administration of platinum drugs has been reported in adults with testicular and head and neck cancers, this study is the first to show that hearing loss and tinnitus are very common problems in survivor of the four most common forms of cancer.

She added that, in good news, “the range of hearing loss that occurs with these compounds is amenable to a hearing aid.” In the study sample, just 17% of survivors were using a hearing aid.

“If we can get the information out there that people should have a high index of suspicion [about potential hearing loss], we can make a difference, because it is treatable with hearing aids,” Miaskowski said.

The average age of cancer survivors in the study was 61 with a Karnofsky Performance Status score greater than 50. They were willing to complete self-report questionnaires, and undergo a 3-hour study visit that included hearing testing. The time since a cancer diagnosis ranged from a median of 3.9 to 6.2 years, depending on the chemotherapy regimen received.

The authors found that 12.8% of the 273 survivors had received a platinum-containing regimen, 56.8% a taxane-containing regimen, and the remaining 30.4% a regimen containing 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 the patients who got a regimen with both compounds had breast cancer.

No differences were found among the three chemotherapy groups in the occurrence rates for self-reported hearing loss prior to the study visit. Across the chemotherapy groups, the occurrence of self reported hearing loss ranged from 30.5% (both platinum and taxane) to 34.3% (only platinum).

Study survivors were classified as having audiogram-confirmed hearing if at any frequency they scored poorer than the 50th percentile for their age and gender.

The authors reported no statistically significant differences among the three chemotherapy groups in the occurrence of audiogram-confirmed hearing loss as well. However, those rates were significantly higher than the self-reported rates, ranging from 52.3% (only taxane) to 71.4% (only platinum).

Of the total sample, 25.4% self-reported hearing loss that was confirmed on audiogram, 31.0% self-reported that they did not have hearing loss that was found on audiogram, 7.4% self-reported hearing loss that was not confirmed on audiogram, and 36.2% self-reported that they did not have hearing loss, and no hearing loss was found on audiogram.

“The prevalence of hearing loss is really, really high in survivors,” Miaskowski stated. Given that a significant proportion of patients are underestimating their hearing loss, and that few of them are using hearing aids, the message for oncologists “is simple,” she said. “Ask patients if they have symptoms. And they need to have an audiogram, because people don’t perceive their hearing loss is as great as it is.”

In the case of tinnitus, survivors were categorized as having that condition if they reported that they were consciously aware of their tinnitus for more than 10% of their time awake. No differences were found among the three chemotherapy groups in the occurrence rates for tinnitus, with rates ranging from 40.3% (only taxane) to 45.7% (only platinum) prior to the study visit, and 37.1% (platinum) to 40.0% (taxane) after the visit.

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 need to evaluate for hearing loss and tinnitus across the continuum of cancer care,” they emphasized. “Our findings suggest that common underlying mechanisms for both hearing loss and tinnitus warrant evaluation in preclinical and clinical studies.”

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