Cisplatin-Based Chemotherapy May Cause Hearing Loss in Cancer Survivors

"Our study highlights the need for regular auditory evaluations to manage and mitigate long-term hearing damage," according to lead study author Victoria Sanchez, AuD, PhD, CCC-A, F-AAA.

Higher doses of cisplatin-based chemotherapy—used in treating patients for various cancers including bladder, lung, neck, and testicular cancer—may cause hearing loss in cancer survivors, according to findings from the interdisciplinary Platinum study published in JAMA Oncology.¹

Of 100 patients at evaluation, 78 (78%) testicular cancer survivors treated with cisplatin-based chemotherapy had audiometrically defined hearing loss. Of the survivors, those with vs without self-reported hearing loss had worse median hearing loss (48 dB vs 24 dB hearing loss; P < .001). Additionally, patients with self-reported hearing loss (n = 54) showed clinically significant functional impairment on words-in-noise (WIN) testing.

“Most patients still do not get their hearing tested prior to, during, or after chemotherapy,” lead author Victoria Sanchez, AuD, PhD, CCC-A, F-AAA, an associate professor at the University of South Florida Health Department of Otolaryngology Head & Neck Surgery, said in a press release on the study.² “Our study highlights the need for regular auditory evaluations to manage and mitigate long-term hearing damage.”

The Platinum study enrolled 100 cisplatin-treated testicular cancer survivors from 2012 to 2018 with ongoing follow-up. The median age at the time of the second assessment was 48 years (range, 25-67), with a median time since chemotherapy of 14 years (range, 4-31). Patients eligible for enrollment on the study had no audiometrically defined profound hearing loss at baseline and had at least 3.5 years since their first audiologic assessment.

Audiometrically defined cisplatin-related hearing loss progression significantly interacted with cumulative cisplatin dose (P = .02). Patients given 300mg/m² or less cisplatin experienced 4.5 times greater odds of having better hearing at follow-up assessment (95% CI, 1.5-13.3; P = .01). By contrast, patients exposed to greater than 300 mg/m2 had no statistically significant difference between initial and follow-up assessment, with a nonsignificant trend of 1.37 times greater odds of having worse hearing (95% CI, 0.52-3.61; P = .51).

Patients reporting hearing loss also had higher cumulative cisplatin doses (345 mg/m² vs 317 mg/m²; P = .03) than patients without self-reported hearing loss. A majority (79%) of survivors reporting hearing loss had mild to profound ASHA-categorized loss; 52% without hearing loss were categorized as normal or slight severity of hearing loss (P = .002).

Furthermore, 69% of survivors without self-reported hearing loss had normal, slight, or mild clinical severity of audiometrically defined hearing loss; and 59% of survivors self-reporting hearing loss had ratings of profound, severe, moderately severe, or moderate loss. Additionally, 73.9% of survivors with hearing loss reported problems hearing in crowds, and 38% had an HHIA-quantified hearing handicap, which moderately correlated with audiometrically defined hearing loss (r = 0.42; P = .003) and WIN performance (r = 0.48, P = .001).

Total median speech recognition threshold (SRT) and word-recognition performance in quiet were 10 dB (range, 0-38) dB hearing loss and 98% (range, 55%-100%), respectively. Survivors with hearing loss performed more poorly vs those without hearing loss on both tests (13 dB hearing loss vs 10 dB hearing loss; 96% vs 98%; P = .02 and .01, respectively). Furthermore, survivors with self-reported hearing loss had mild (38.9%), moderate (9.3%), or severe (5.6%) WIN-quantified functional impairment vs those without self-reported hearing loss (13%, 0%, and 0%, respectively; P <.001).

Primary end points were audiometrically measured hearing loss defined as combined-ears high frequency pure-tone average (4-12 kHz) and speech-recognition in noise performance measured with WIN. Larger percentages of survivors with hearing loss had hypertension (37%; P = .03) hypercholesterolemia (46%; P = .01), and tinnitus (80%; P < .001).

“Tests such as WIN and other neurophysiological measures [eg, auditory evoked potentials] should be included in future investigations of [cisplatin-related hearing loss] and its progression. Our findings highlight the need for additional longitudinal assessments in research protocols as well as in standard of care,” the authors of the study concluded.¹

References

1. Sanchez VA, Dinh PC, Monahan PO, et al. Comprehensive audiologic analyses after cisplatin-based chemotherapy. JAMA Oncol. Published online June 6,2024. doi:0.1001/jamaoncol.2024.1233
2. Delamarter C. Chemo drug may cause significant hearing loss in longtime cancer survivors. News release. University of South Florida. June 27, 2024. Accessed July 3, 2024. https://tinyurl.com/yj2ausjt