Severe Hearing Impairment in Childhood Cancer Survivors May Be Linked to Neurocognitive Deficits

Study results published in JAMA Oncology suggested that severe hearing impairment in childhood cancer survivors is associated with neurocognitive deficits independent of the neurotoxic treatment received.¹

Given these findings, researchers indicated that early screening and intervention for hearing impairment, including adherence to hearing aids and cochlear implants, neuropsychological consultation, and educational accommodations, may promote the development and maintenance of neurocognitive function and may also identify individuals at risk for future impairment.

“Even patients not exposed to neurotoxic therapies who develop mild hearing deficits can have problems with their neurocognitive skills,” senior author Kevin Krull, PhD, of St. Jude Epidemiology and Cancer Control, said in a press release.² “This makes it important to identify these patients early and suggest interventions to help improve their hearing and thus their neurocognitive outcomes.”

In this cross-sectional study, researchers used data from participants included in the St. Jude Lifetime Cohort Study (SJLIFE), an ongoing study which quantifies the long-term health outcomes of childhood cancer survivors. Participants included those treated at St. Jude Children’s Research Hospital for childhood cancer who survived 5 or more years after their original diagnosis and who were eligible for audiologic and neurocognitive testing.

Overall, 1520 childhood cancer survivors were evaluated. Those included in the study were grouped by hearing sensitivity (normal hearing [Chang grade 0], mild hearing impairment [Chang grades 1a, 1b, and 2a], or severe hearing impairment [Chang grade ≥2b]) and stratified by treatment exposure (platinum-only exposure group [treated with cisplatin and/or carboplatin chemotherapy], cochlear radiotherapy [RT] exposure group [treated with cochlear RT with or without platinum-based chemotherapy], or no exposure group [no platinum-based chemotherapy or cochlear RT]).

Among the survivors, prevalence and risk of severe hearing impairment were higher in those in the platinum-only (n = 107 [34.9%]; relative risk [RR], 1.68; 95% CI, 1.20-2.37) or cochlear RT (n = 181 [38.3%]; RR, 2.69; 95% CI, 2.02-3.57) exposure group compared with those in the no exposure group (n = 65 [8.8%]).

Moreover, severe hearing impairment, compared with survivors with normal hearing or mild hearing impairment, was correlated with deficits in the following:

• verbal reasoning skills (no exposure group RR, 1.11; 95% CI, 0.50-2.43; platinum-only exposure group RR, 1.93; 95% CI, 1.21-3.08; cochlear RT exposure group RR, 2.00; 95% CI, 1.46-2.75)
• verbal fluency (no exposure group RR, 1.86; 95% CI, 1.19-2.91; platinum-only exposure group RR, 1.83; 95% CI, 1.24-2.71; cochlear RT exposure group RR, 1.45; 95% CI, 1.09-1.94)
• visuomotor speed (no exposure group RR, 1.87; 95% CI, 1.07-3.25; platinum-only exposure group RR, 3.10; 95% CI, 1.92-4.99; cochlear RT exposure group RR, 1.40; 95% CI, 1.11-1.78)
• mathematics skills (no exposure group RR, 1.90; 95% CI, 1.18-3.04; platinum-only exposure group RR, 1.63; 95% CI, 1.05-2.53; cochlear RT exposure group RR, 1.58; 95% CI, 1.15-2.18)

“This finding supports the need for long-term audiologic follow-up and early [hearing impairment] detection and intervention in a population already at risk for neurocognitive deficits,” the authors wrote. “A neuropsychological consultation may help identify areas of low performance sooner and thus prevent or mitigate the association between [hearing impairment] and neurocognition.”

While research in this field continues, Wendy Landier, PhD, RN, CRNP, associate professor in the Division of Pediatric Hematology-Oncology and the School of Nursing at the Institute for Cancer Outcomes and Survivorship at the University of Alabama at Birmingham School of Medicine, suggested in an editorial that the findings highlighted by this study should be considered by clinicians caring for this patient population.³ More specifically, Landier indicated that these findings highlight the importance of providing parents with anticipatory guidance regarding the need for audiologic monitoring and management of children receiving possibly ototoxic agents.

“Pediatric oncology clinicians can foster parental understanding of the critical consequences of hearing loss for a young child’s development, and set expectations for ongoing audiologic monitoring and early audiologic rehabilitation — beginning during therapy and continuing throughout recovery,” Landier wrote. “Across the survivorship continuum, the importance of ongoing audiologic care can be emphasized by clinicians as an expectation for survivors identified with, or potentially at risk for, treatment-related hearing loss — with consideration given to broadening audiologic screening to include survivors not typically in the ‘at-risk’ platinum and [cranial radiotherapy] groups.”

References:

1. Bass JK, Liu W, Banerjee P, et al. Association of Hearing Impairment With Neurocognition in Survivors of Childhood Cancer. JAMA Oncology. doi: 10.1001/jamaoncol.2020.2822.

2. Hearing loss linked to neurocognitive deficits in childhood cancer survivors [news release]. Published July 28, 2020. newswise.com/articles/hearing-loss-linked-to-neurocognitive-deficits-in-childhood-cancer-survivors?sc=mwhr&xy=10019792. Accessed August 6, 2020.

3. Landier W. Seeing (Hearing Loss) With Fresh Eyes. JAMA Oncology. doi: 10.1001/jamaoncol.2020.2639.