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With 74% of testicular cancer survivors reporting hearing loss in a recent study, one expert advised patients to advocate for themselves and their hearing before, during and after cancer treatment with cisplatin-based chemotherapy.
Three out of four testicular cancer survivors reported experiencing ototoxicity — damage to the inner ear caused by a toxic agent — after treatment with a cisplatin-based chemotherapy, according to findings from a recent study.
“Specifically for chemotherapy, platinum-based chemotherapies are known to be very ototoxic because they cause an inflammatory response in the inner ear, essentially causing cell damage, which causes hearing loss and sometimes tinnitus, or ringing or buzzing noises from the ear,” said Victoria A. Sanchez, assistant professor in the department of otolaryngology at the University of South Florida in Tampa, in an interview with CURE®.
In the study published in the Journal of Cancer Survivorship, Sanchez and colleagues analyzed questionnaire responses from 145 testicular cancer survivors who were treated with cisplatin-based chemotherapy. Of these patients, 74% reported ototoxicity, 68% reported tinnitus and 52% reported both.
CURE® spoke with Sanchez to learn more about ototoxicity from cisplatin-based chemotherapy, what patients should know about its symptoms and how patients can advocate for themselves during treatment and beyond.
Does ototoxicity lead to permanent or temporary changes to the ear?
For what we understand, it seems to be permanent and also potentially progressive, meaning any damage caused from the chemo is likely going to be there and may even get worse because the cisplatin is known to be retained in the inner ear for life. Once it gets in there, it stays in there, which is the really alarming part. It doesn't go away ever.
Although your study focused on testicular cancer survivors, can this occur in other cancer types?
That is correct, yes. So cisplatin-based chemo is one of the most widely used chemos for lots of different types of cancers. And anytime cisplatin-based chemo is used, it is likely ototoxic. So for the cancer, regardless of male or female or race, if you're receiving cisplatin-based chemotherapy, there's a high risk of having ototoxicity.
What are the symptoms of ototoxicity that patients should be aware of?
And is there a way to prevent this from happening?
During chemo, if the patient starts to notice hearing loss, hearing difficulty or tinnitus, they should definitely alert their oncology care team immediately.
And then sometimes it's not noticeable during treatment, and you can maybe start to notice these things even after treatment. So it's definitely recommended before treatment to get a hearing evaluation so you know what you're going into chemo with. Then if you start to notice any problems, you can get tested along the way, and then definitely after chemo.
Testing is super important because there is no prevention. It's very important to be aggressive against cancer for lifesaving reasons, we want to get rid of the cancer, but there's no prevention tactics for ototoxicity.
Now sometimes, if hearing loss is starting to develop, the oncology team may be able to look at the dosage and potentially make some adjustments but saving the patient's life and curing the cancer is still No. 1.
Is there any way to prevent the progression of ototoxicity-related hearing loss?
Right now, there are no preventatives. But sometimes education can be very helpful, such as not engaging in environments that have really loud noises or receiving other ototoxic medications. Being aware that now that you have a hearing loss, it may continue to get worse, so try your best to protect your ears after that loss has occurred.
Once a patient is considered to be experiencing ototoxicity, are there any treatments to potentially manage it?
There are no treatments to fix the hearing loss. The hearing loss is permanent and irreversible. There's lots of research groups trying really hard to discover a treatment option, but there are none available at this time.
That's true for not only ototoxicity, but all sensory neural hearing losses, which is damage the inner ear. So sensory neural hearing loss is the most prevalent form of hearing loss, and there are no treatments for it whatsoever. The only thing that we can do is provide rehabilitation in the form of devices, such as hearing aids, and educational support, such as teaching people to do better with the hearing that they have left.
In the study, you and your colleagues found that survivors who experienced hearing loss were more likely more likely to report diabetes, high blood pressure and high cholesterol. Regarding heart disease-related risks, do we know what the connection is between hearing loss and those risks?
We don't know exactly if there's a causal relationship; we just know that there is a relationship. And that those with vascular diseases are an increased likelihood of also having hearing loss. We think that there's a connection, and what we would hope is to promote healthy lives and lifestyles. We can do our best to promote healthy hearing and also healthy lifestyles to promote healthy living, such as making sure that diabetes or hypertension is well managed, either through medication or lifestyle factors, exercise, diet and so forth.
What advice would you give patients who may be at risk for ototoxicity?
If you're going to undergo chemotherapy, you're at risk just because you're about to receive that chemotherapy. And then there's lots of other things that also could put you at risk, too. So there's some of those things are non-modifiable. And some of those things are modifiable. So you'd want to communicate with your doctor about what factors could be modifiable, which ones could you potentially be able to do to reduce your risk and reduce your likelihood of having severe hearing loss or other side effects that come from chemotherapy treatment.
And then on top of that, if you end up having a hearing loss from ototoxicity, then it's really managing the hearing loss and making sure that patients are educated with what's out there to help with their hearing, and also continue to protect their hearing as best as possible.
Now, because there's no cure or treatment to fix hearing, there are hearing aids. There is some stigma around hearing aids, but there's also other barriers as well.
We're not quite sure exactly why there's a lower uptake of hearing aids; less than 20% of the American population that has hearing loss utilizes hearing aids. So all of that cannot necessarily all be stigma, we also think that there's access barriers, insurance barriers and cost barriers. There's lots of research right now to try to reduce those barriers so we can get hearing services to the patients who need them.
But if hearing loss does happen because of chemo, that we would really encourage to seek audiological care to use a hearing aid, if recommended, and to make sure to use them because untreated hearing loss have lots of negative consequences.
Untreated hearing loss is associated with increase in hospitalization, increase in falls, decrease in quality of life, increases in depression and an increased risk of cognitive decline and dementia. We know untreated hearing loss can be associated with cognitive decline. And there's evidence growing that treating hearing loss can help reduce your risk of cognitive decline in hearing loss and dementia.
How can patients advocate for themselves?
Oncologists have really important jobs of evaluating the cancer and what's the best approach to kill the cancer. But it's also important for the patient to communicate to the oncologist that their hearing is really important. How is this going to be affected? Can I make sure I'm getting all the appropriate testing? Can we make adjustments if possible? And now that I'm on the other side of cancer, send the oncologists and the patients to the appropriate places to receive the best practices and hearing services that are available.
This transcription has been edited for clarity and conciseness.
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