Study yields new insights into extent of, risk factors for cisplatin-related hearing loss
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A longitudinal cohort study has yielded new insights into risks for and long-term effects of cisplatin-related hearing loss.
Higher cisplatin doses led to more severe and progressing hearing loss, researchers found. Factors such as high blood pressure or poor cardiovascular health magnified this risk.
The findings support the need for regular audiological assessments and hypercholesterolemia control for cancer survivors treated with cisplatin, investigators concluded.
“Cisplatin stays in the ear indefinitely so, as soon as someone has a cisplatin-based treatment, they will have that toxic drug inside their ear for the rest of their lives,” study co-author Victoria A. Sanchez, AuD, PhD, CCC-A, F-AAA, associate professor in the department of otolaryngology — head and neck surgery at University of South Florida, told Healio. “It’s very important that we monitor them carefully and provide them with information and education about this effect.”
Sanchez and colleagues conducted comprehensive follow-up audiologic assessments and assessed patient-reported outcomes among cisplatin-treated testicular cancer survivors who participated in The Platinum Study, an NCI-funded multicenter investigation.
The analysis included 100 survivors (median age, 48 years; range, 25-67), none of whom had profound hearing loss prior to chemotherapy (baseline). Median time since chemotherapy was 14 years (range, 4-31).
More than three-quarters (78%) experienced significant difficulties in everyday listening situations. More than half (54%) of patients with self-reported hearing loss exhibited clinically significant functional impairment on Words-in-Noise (WIN) tests, which assess a person’s ability to recognize single words amid different levels of background noise.
Multivariable analysis showed associations between poorer performance on WIN testing and hypercholesterolemia (beta = 0.88; 95% CI, 0.08-1.69), lower education (F1 = 5.95; P = .004) and severity of hearing loss (beta = 0.07; 95% CI, 0.06-0.09).
Progression of cisplatin-related hearing loss correlated with hypercholesterolemia (beta = 4.38; 95% CI, 7.42 to 1.34) and increasing age (beta = 0.33; 95%CI, 0.15-0.5). Cumulative cisplatin dose also appeared significantly associated with cisplatin-related hearing loss progression (F1 = 5.98; P = .02).
Healio spoke with Sanchez about the findings and the importance that cisplatin-treated cancer survivors receive comprehensive follow-up.
Healio: What had already been established about cisplatin’s effects on hearing?
Sanchez: We knew cisplatin could have a negative effect on hearing across the lifespan; it was thought to have more of a negative effect on young children. The effects of cisplatin among cancer survivors has been poorly researched in adult populations and, because of this, sometimes clinicians thought hearing loss was short-lived. We have been generating clear, obvious evidence that the prevalence of hearing loss is high and does not get better. In fact, it can get worse.
Healio: How did you conduct this analysis?
Sanchez: The Platinum Study began long before I became involved, but in the last 5 or 6 years we’ve pulled in a few hearing scientists, including myself, to ask questions about the impact of cisplatin on the auditory system. We designed a test battery that, for the first time, allowed us to get repeated and comprehensive measurements. Patients had undergone hearing tests before. We repeated those tests and provided others, such as a test to measure a person’s ability to understand speech and noise. Many hearing tests only consist of a series of beeps. Most people want to be in vibrant listening environments — out with their families, at restaurants or in other public places — so we wanted to know how people functioned in real-world environments. We used a standardized test that allows us to quantify someone’s ability to understand speech in a background noise environment.
Healio: What did you find?
Sanchez: Because we had such a rich database, we could look at our data using statistical modeling. This helped us tease out what could be related to the progression of hearing loss and a person’s ability to understand speech and noise.
We found that cardiovascular insults like high cholesterol were associated with increases in hearing loss and poor ability to understand speech and noise. This speaks to how cardiovascular conditions can accelerate or exacerbate other conditions. Our ears are very sensitive; there are little vascular structures in there that have already been insulted with cisplatin. Having poor cardiovascular circuitry through the inner ear is associated with even more damage.
Healio: What are the potential implications of the findings?
Sanchez: It’s very important that we educate these individuals about the prevention of further hearing loss. These patients can’t change the fact that they were exposed to an ototoxic agent, but they can make other changes. This can involve avoiding loud noises and other things that could further damage their ears, as well as ensuring good cardiovascular health. We also hope this will generate conversations among oncology colleagues to consider lower doses of ototoxic medications if possible. Of course, curing the cancer and saving a person’s life is the number one priority, but patients need to be aware of what their quality of life will look like after they’ve survived cancer.
Healio: Is the possibility of hearing loss discussed prior to treatment selection?
Sanchez: Unfortunately, it often isn’t. It’s on a long list of concerns that a patient must deal with. Some providers might mention it but, as an audiologist, I often have patients tell me they weren’t aware of this effect. Patients typically remember about 20% of what a health care provider told them; so, even if someone did tell them this, it apparently is not remembered. We have an opportunity to educate our colleagues in other health care disciplines and encourage them to ensure they are educating patients about this and discussing the possibility of a patient going to an audiology clinic.
Healio: Is there anything else you’d like to mention?
Sanchez: The prevalence of hearing loss that we have identified is very high, and we’re also noticing that most people are not treating their hearing loss. There are many efficacious treatments, such as hearing aids. There sometimes is a stigma around hearing aids, but they have evolved into very high-tech digital sensory devices that truly can help improve hearing. Untreated hearing loss is connected to many negative health outcomes, such as social isolation, depression, increased risk for falls and greater risk for cognitive decline. Hearing aids can reduce some of those risks, so something simple can have a substantial impact on a person’s quality of life and overall health.
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For more information:
Victoria A. Sanchez, AuD, PhD, CCC-A, F-AAA, can be reached at vasanchez@usf.edu.
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