Impact of Cisplatin-Based Chemotherapy on Hearing in Cancer Survivors

Researchers have uncovered the long-term effects of cisplatin-based chemotherapy on the hearing of cancer survivors, according to a recent study published by Sanchez et al in JAMA Oncology.

Background

Cisplatin is commonly used in chemotherapy to treat a variety of cancer types, including urothelial, lung, neck, and testicular cancers. The treatment is administered intravenously and affects various parts of the body. However, because the ears are particularly vulnerable and have little ability to filter out the drug, cisplatin can become trapped—leading to inflammation, the destruction of sensory cells that are critical for coding sound, and permanent hearing loss that can progressively worsen well after the completion of cisplatin-based chemotherapy.

“It’s important that we understand the real-world effects of patients’ sensory problems and if we can understand that, then we can develop better therapeutic strategies and preventive measures to improve the long-term quality of life for cancer survivors,” explained co–study author Robert Frisina, PhD, Distinguished University Professor and Chair of the Department of Medical Engineering at the University of South Florida (USF).

Despite the known risks, there are currently a lack of routine hearing assessments among U.S. patients undergoing chemotherapy.

Study Methods and Results

In the interdisciplinary Platinum Study, the researchers examined the real-world listening challenges and hearing loss progression of testicular cancer survivors who received cisplatin-based chemotherapy.

After an average follow-up of 14 years, the researchers found that 78% of them experienced significant difficulties in everyday listening situations, negatively impacting their quality of life. Higher doses of cisplatin led to more severe and progressive hearing loss—especially in patients with risk factors such as high blood pressure and poor cardiovascular health. They also experienced increased difficulty hearing in common environments like louds restaurant.

“It will be critically important to follow these patients for life. Their current median age is only 48 years, and eventually they will enter the years at which age-related hearing loss also begins to develop,” stressed senior study author Lois B. Travis, MD, ScD, the Lawrence H. Einhorn Professor of Cancer Research at the School of Medicine and a researcher at the Melvin and Bren Simon Comprehensive Cancer Center at Indiana University.

Conclusions

“Most patients still do not get their hearing tested prior to, during, or after chemotherapy. Our study highlights the need for regular auditory evaluations to manage and mitigate long-term hearing damage,” emphasized lead study author Victoria Sanchez, AuD, PhD, Associate Professor in the Department of Otolaryngology Head & Neck Surgery at USF Health.

The researchers hope their findings will inspire further investigation into alternative chemotherapeutic protocols and preventive measures, such as U.S. Food and Drug Approved–approved drugs to prevent or reduce hearing loss. According to the American Cancer Society, in addition to cisplatin, other platinum chemotherapy drugs, including carboplatin, may cause damage to the cochlea in the inner ear and lead to hearing loss. The risk of damage may be greater with higher doses of chemotherapy.

“This research gives oncologists the information they need to explore alternative treatment plans that could reduce the long-term side effects—such as altering the dosages and timing of the cisplatin in the treatment—when that could be an appropriate option,” Dr. Frisina suggested.

“We want to protect our hearing or treat a hearing loss if hearing damage occurs. Hearing allows [individuals] to connect to the world [they] love. Staying connected through conversations with family and friends, enjoyment of music, and entertainment, [allow individuals to remain] safe and find pleasure in [their] vibrant surroundings. Promoting optimal hearing for overall wellness is essential for healthy living,” Dr. Sanchez concluded.

Disclosure: The research in this study was funded by the National Cancer Institute. For full disclosures of the study authors, visit jamanetwork.com.