Researchers at the University of California-San Francisco discovered more than half of the survivors of breast, gastrointestinal, gynecologic or lung cancer in their study who had received chemotherapy ended up with significant hearing problems. Photo by James Musallam/Wikimedia Commons
Post-chemotherapy hearing loss and ringing in the ears, called tinnitis, affect the majority of adult survivors of the most common cancers, and routine hearing screening is needed, new research suggests.
Researchers at the University of California-San Francisco discovered more than half of the survivors of breast, gastrointestinal, gynecologic or lung cancer in their study who had received chemotherapy ended up with significant hearing problems.
The federally funded study was published Wednesday in BMJ Supportive & Palliative Care.
Given that hearing loss and tinnitus are not routinely assessed in adult patients who are treated with chemotherapy for these common cancers, and many may have a certain amount of age-related hearing loss, they should be evaluated for hearing problems before, during and after treatment, the investigators said.
Christine Miaskowski, the study’s principal investigator, said there’s a straightforward explanation why hearing problems after chemotherapy have been overlooked.
“[W]ith the exception of pain and fatigue which are routinely assessed in oncology patients, clinicians do not ask about other symptoms,” Miaskowski told UPI via email. “That’s because the “primary focus is on curing the disease, not on an evaluation of the side effects of chemotherapy,” she said.
But, Miakowski, a UCSF professor and vice chair for research, said issues such as hearing loss “persist into survivorship and have a significant negative impact on various aspects of patients’ quality of life.”
Previous studies have found hearing loss in children with cancer and adults with testicular cancer or head and neck cancer who received chemotherapy regimens using platinum drugs, Miaskowski said.
But the new study is the first to demonstrate that hearing loss and tinnitus are highly prevalent problems in survivors of the four most common types of cancer.
The researchers found high rates of hearing loss and tinnitus occurring not only with platinum drugs, but with another class of chemotherapy drugs called taxanes, which can produce nerve damage.
Platinum- and taxane-containing chemotherapy regimens are used commonly to treat the majority of cancers, they noted.
“Patients and survivors who receive these nerve damage chemotherapy regimens need to have their hearing tested prior to starting chemotherapy, at the completion of chemotherapy, and every year following the completion of chemotherapy,” Miaskowski said.
She said the most surprising finding in the study was the high occurrence rates for hearing loss with the taxane-containing chemotherapy regimens.
While hearing loss from platinum and taxane drugs is permanent, people can benefit from using a hearing aid, the researchers said.
The fact that only 17% of cancer survivors in the study were using a hearing aid suggests that clinicians must routinely refer them for hearing tests, they noted.
“This issue is a simple one to address. Hearing tests are readily available,” Maskowski said. “The main thing to note is that the hearing loss associated with neurotoxic chemotherapy improves with a hearing aid.”
She added: “Patients need to be told about this common adverse effect of chemotherapy.”
The study included 273 cancer survivors, averaging 61 years old, who had completed cancer treatment about five years earlier.
Overall, more than 50% of them experienced significant hearing loss, as confirmed by an audiogram, a type of hearing exam, and more than 35% reported tinnitus.
Those study participants with hearing loss reported moderate to severe levels of impairment with routine activity, such as listening to television or radio, talking with family members and friends or conversing in restaurants, a news release said.
Those with tinnitus reported that this problem interfered with their ability to concentrate or relax, their mood and enjoyment of life, and their sleep.
The investigators said hearing loss often is underestimated. While 31% of the study’s participants denied having the problem, they were found later to have hearing impairment on audiometry.
Miaskowski said the research team is awaiting word on a proposed study, now under review at the National Cancer Institute, that would enroll patients before chemotherapy and follow them for 12 months.
“In addition to hearing loss and tinnitus, we will evaluate for another devastating effect of nerve damage drugs, namely chemotherapy-induced peripheral neuropathy,” she said.