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3 Questions on…

Answers straight from the experts on the latest news and topics in oncology

Tuesday, June 9, 2020

3 QUESTIONS ON...Why Addressing Hearing Loss in Survivors of Childhood Cancers Matters

With Emily S. Tonorezos, MD, of the Adult Long-Term Follow-Up Program at Memorial Sloan Kettering Cancer Center

By Sarah DiGiulio

Hearing loss is a common side effect of cancer treatment. Yet several studies suggest that many survivors of childhood cancers either do not treat this problem or significantly delay treatment. It’s problematic because there are significant consequences of untreated hearing loss when it comes to one’s health and well-being.

That’s why Emily S. Tonorezos, MD, a general internist at the Adult Long-Term Follow-Up Program at Memorial Sloan Kettering Cancer Center (MSKCC), and a group of fellow researchers set out to do a qualitative analysis of 24 adult survivors of childhood cancers who were at risk for hearing loss after treatment. The data was published in the journal Cancer (2020;126:1776-1783).

The researchers conducted semi-structured telephone interviews with each participant to ask questions about what treatment for hearing loss had been sought out, how long after cancer treatment each person had sought out treatment for hearing loss, and what effects the hearing loss had on other parts of the participants’ health and quality of life.

The conclusion the researchers came to for the study was that “clinicians play an important role in initiating the discussion regarding hearing loss with survivors given the importance of hearing in maintaining social relationships, the availability of hearing care interventions, and the invisibility of hearing loss. Education regarding the value of treatment may have implications for how survivors choose to prioritize hearing loss and seek care.” In an interview with Oncology Times, Tonorezos shared more about the research.

1. What were the key findings from this research and why was it so important to ask these questions now?
“This work came directly from our prior study, published in Children, that showed around half of childhood cancer survivors with hearing loss were not using hearing aids (2018; doi:10.3390/ children5050059). Other studies of childhood cancer survivors have shown the same thing. From our clinical experience, we thought perhaps hearing aids were stigmatized, expensive, or uncomfortable for survivors. But we were not sure.

“We conducted 24 interviews which underwent qualitative analysis. In brief, the survivors themselves told us what the issues are. 

"This study had three major findings: 1) post-treatment hearing loss is associated with isolation and feelings of exclusion; 2) clinicians play an important role in providing survivors with education regarding hearing loss and hearing aids; and 3) hearing loss for survivors may be deprioritized because it is a reminder of the cancer history and is interpreted within the context of other treatment-related late effects.

“As I mentioned, we had some theories as to why survivors were not using hearing aids, but we did not anticipate that illness burden or the fact that these patients have many appointments and medical needs would be important.”

2. What is the current standard of care when it comes to making sure that  survivors of childhood cancers be tested and treated for hearing loss?

“Guidelines for who should be tested come from the Children’s Oncology Group (www.survivorshipguidelines.org). The patients in our study were aware they were at risk for hearing loss, and many of them were struggling with their hearing.

“The next step [of this work] is to develop an intervention to help survivors better cope and manage their medical needs. We are doing [more research] to develop it, but we are planning to be technologyforward and will engage a web-based platform.

“The team is collaborating with other MSKCC researchers, as well as others from University of North Carolina and Hunter College in New York City on this next step.”

3. What’s the bottom line all practicing oncologists and cancer care providers should know about your work?

“There are a few take-home messages. For one, providers should be aware that survivors who are experiencing hearing loss may feel lonely and isolated, and at the same time may not have the time or capacity to seek treatment.

“We do have the ability to positively impact survivors’ lives by helping them coordinate and manage this aspect of their care. What we heard from survivors who had been struggling with hearing loss and then got hearing aids was amazing. [The hearing aids] can be life-changing. Hopefully our current and ongoing work will help make this process easier.”