Screening for Hearing Loss in Hematologic Cancer Survivors

Background and Significance

There are more than 18 million cancer survivors in the United States and approximately 32 million survivors worldwide (Miller KD, 2022). Adult cancer survivors are at higher risk for developing hearing loss (HL) due to their older age, prior cancer treatment such as chemotherapy and radiotherapy, with a significantly higher prevalence of HL in adults who survived cancer compared to the general population in the United States (Wang et al., 2023). To our knowledge the prevalence of HL in cancer survivors with hematologic malignancies, nor the rates of HL screening referral among this population remain unknown.

Methods

We performed a retrospective cohort study using a de-identified national database from TriNetX Research Network. We identified all adult patients (age ≥ 18 years) with a diagnosis of hematologic malignant neoplasm after 1/1/2015 and had an assessment for auditory evoked potentials any time before or after neoplasm diagnosis. Patients with a HL diagnosis before diagnosis of hematologic malignancy were excluded. We investigated the outcome of HL occurring at least 1 day after the cancer diagnosis and/or treatment. The outcomes included 1) HL, which was defined as having a diagnosis of conductive or sensorineural hearing loss; 2) referral for HL testing, which was defined as having an examination for hearing loss or having an audiologic function test; and 3) tinnitus. Chi-squared test was used to determine the association between cancer treatments (chemotherapy only, radiation [RT] only, combined chemotherapy and RT, other treatment and no treatment) and HL outcomes. P-values of α<0.05 were considered statistically significant.

Results

We identified 6,666 patients with hematologic malignancies overall. 40.2% of patients treated with RT-only had a HL diagnosis, followed by RT and chemotherapy (38.6%), chemotherapy only 38.0% and other treatment 36.5% (p<0.001). Patients treated with chemotherapy (21% (OR=0.79; 95% CI: 0.70-0.90)) and other treatment (26%, 95%CI: 0.64-0.86) were less likely to have a HL diagnosis compared to patients who did not get any treatment, respectively. Patients who received RT-only and combined chemotherapy and RT were also less likely to have HL diagnoses (OR=0.87; 95%CI: 0.69-1.09 and OR=0.81; 95%CI: 0.61-1.08, respectively) but not statistically significant.

Overall, less than one third of patients had an audiologic function test across all treatment groups (21.3% in chemotherapy, 27.0% in RT therapy, 27.1% in both chemotherapy and 20.5% in other treatment, p<0.001). Patients who had received chemotherapy and other treatment were less likely to receive an audiologic function test OR=0.77, 95% CI:0.66- 0.89 and OR=0.73, 95%CI: 0.61-0.87, respectively, compared to those who did not receive any treatment. No significant differences were found between RT only and combined chemotherapy and RT therapy vs no treatment.

Patients treated with combined chemotherapy and RT had the highest prevalence of tinnitus 21.3%, followed by other 16.7%, chemotherapy only 16.2% and RT-only 12.9% (p=0.13). Compared to patients who did not receive any treatment, those who received RT treatment were 28% (OR=0.72; 95%CI; 0.51-1.00) less likely to have tinnitus. Numerically increased odds of tinnitus were observed in patients treated with combined chemotherapy and RT but not statistically significant (OR=1.32; 95%CI: 0.92-1.84) compared to patients with no treatment. No significant difference was observed in other treatment and chemotherapy only groups.

Conclusion

We found that more than one third of patients with hematological malignancies had a HL diagnosis, regardless of prior treatment types. However, less than one third of patients have ever had an audiologic function test. Our study also suggests that patients treated with chemotherapy are less likely to be referred for hearing tests and diagnosed with HL. One possible explanation is that patients with hematologic malignancies and at risk of HL may be less likely to receive chemotherapy and those who received chemotherapy were younger and less likely to have HL. HL is associated with increased risk of depression, fall, hospitalization and social isolation. As the longevity of cancer survivors continues to improve, it is critical for health care providers to be aware of this subtle but important side effect, and screen for HL in high-risk cancer survivors.

No relevant conflicts of interest to declare.