An interdisciplinary study led by researchers from the University of South Florida (USF) and Indiana University has unveiled critical insights into the long-term effects of cisplatin-based chemotherapy on cancer survivors.
Published in JAMA Oncology, the comprehensive research highlights the significant auditory challenges faced by survivors who have been treated with cisplatin.
Long-Term Impact on Hearing
The study tracked 100 testicular cancer survivors over an average period of 14 years, revealing that 78% of these individuals experience significant hearing loss, impacting their daily lives. This collaborative research is notable for being the first to measure real-world listening challenges and the progression of hearing loss in cancer survivors over such an extended period.
Dr. Robert Frisina, distinguished university professor and chair of the USF Department of Medical Engineering, emphasized the importance of understanding the real-world effects of sensory problems in patients. “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,” said Frisina.
Mechanisms of Cisplatin-Induced Hearing Loss
Cisplatin, a chemotherapy drug administered intravenously, is commonly used to treat various cancers, including bladder, lung, neck, and testicular cancers. While effective against cancer, cisplatin is highly ototoxic, meaning it can cause damage to the inner ear. The drug accumulates in the ear due to its inability to be filtered out, leading to inflammation and destruction of sensory cells critical for hearing.
This damage is often permanent and can worsen over time.
Key Findings from the Study
Lead author Dr. Victoria Sanchez, associate professor in the USF Health Department of Otolaryngology Head & Neck Surgery, highlighted a critical gap in current medical practice:
“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.”
The study found that higher doses of cisplatin led to more severe and progressive hearing loss. Patients with risk factors such as hypercholesterolemia, hypertension, and poor cardiovascular health were particularly vulnerable. These individuals also reported increased difficulty hearing in common environments, such as noisy restaurants.
Dr. Lois B. Travis, Lawrence H. Einhorn Professor of Cancer Research at Indiana University School of Medicine, stressed the importance of lifelong follow-up for these patients. “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” said Travis. This research is part of The Platinum Study, an ongoing research effort funded by the National Cancer Institute to study cisplatin-treated testicular cancer survivors.
Audiologic Assessments and Risk Factors
The study’s comprehensive audiologic assessments included Words-in-Noise (WIN) tests and full-spectrum audiometry. The researchers found that poorer WIN performance was significantly associated with hypercholesterolemia, lower education levels, and the severity of cisplatin-related hearing loss (CRHL).
Additionally, CRHL progression was linked to hypercholesterolemia and increasing age. Importantly, a significant interaction between time and cisplatin dose was observed: patients receiving 300 mg/m2 or less experienced significantly less hearing loss progression compared to those receiving higher doses.
Implications for Future Treatment
The findings of this study have significant implications for oncologists and healthcare providers. Dr. Frisina noted that this research provides valuable information for exploring alternative treatment plans that could reduce long-term side effects.
“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.”
Innovative solutions are also on the horizon. Pedmark, a new FDA-approved injection, has shown promise in mitigating cisplatin-induced hearing loss in children. Such advancements represent hopeful steps forward in protecting hearing health for those undergoing cancer treatment.
Citation:
- Sanchez VADinh PCMonahan PO, et al. Comprehensive Audiologic Analyses After Cisplatin-Based Chemotherapy. JAMA Oncol. Published online June 06, 2024. doi:10.1001/jamaoncol.2024.1233
Source: USF, JAMA Oncology
