Study finds Chemo medicine may cause significant hearing loss in longtime cancer survivors

Researchers from Indiana University and the University of South Florida conducted an interdisciplinary study, yielding significant findings about the long-term effects on cancer survivors of a commonly used type of chemotherapy.

The Journal of the American Medical Association Oncology published a study that followed a group of testicular cancer survivors who had undergone cisplatin-based chemotherapy for an average of 14 years. The study revealed that 78% of these survivors face considerable challenges in everyday listening situations, adversely impacting their quality of life. This interdisciplinary research is the first to investigate the long-term progression of hearing loss and real-world listening difficulties in cancer survivors.

"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 Robert Frisina, distinguished university professor and chair of the USF Department of Medical Engineering.

Cisplatin, a widely used chemotherapy drug for cancers such as bladder, lung, neck, and testicular, is administered intravenously and impacts various body parts. The ears are especially susceptible because they cannot effectively filter out the drug, causing it to accumulate. This accumulation results in inflammation and the destruction of sensory cells vital for hearing, leading to permanent hearing loss that can worsen even after cisplatin treatment has ended.

Lead author Victoria Sanchez, an associate professor in the USF Health Department of Otolaryngology-Head & Neck Surgery, noted that despite the well-documented risks, there is a widespread absence of routine hearing evaluations for patients receiving chemotherapy. "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 research team discovered that higher doses of cisplatin resulted in more severe and worsening hearing loss, particularly in patients with risk factors like high blood pressure and poor cardiovascular health. These patients also faced greater difficulty hearing in typical environments, such as noisy restaurants.

"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 Dr. Lois B. Travis, Lawrence H. Einhorn Professor of Cancer Research at Indiana University School of Medicine and a researcher at the IU Melvin and Bren Simon Comprehensive Cancer Center. This research is a component of The Platinum Study, an ongoing project directed by Dr. Travis and financed by the National Cancer Institute, which investigates survivors of testicular cancer who have been treated with cisplatin.

The goal of this study is to encourage additional research into alternative chemotherapy protocols and preventive strategies, including FDA-approved drugs to prevent or mitigate hearing loss.

"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," Frisina said.

Innovative treatments like Pedmark, a newly FDA-approved injection designed to reduce cisplatin-induced hearing loss in children, represent significant progress, as noted by Frisina.

"We want to protect our hearing or treat a hearing loss if hearing damage occurs," Sanchez said. "Hearing allows us to connect to the world we love. Staying connected through conversations with family and friends, enjoyment of music and entertainment, staying safe and finding pleasure in our vibrant surroundings. Promoting optimal hearing for overall wellness is essential for healthy living."