Survivors' perspectives on cisplatin-induced ototoxicity and barriers to ototoxicity monitoring.

PURPOSE: Cisplatin-based chemoradiation therapy (CRT) causes ototoxicity in survivors of head and neck (H&N) cancer, but rates of audiologic follow-up are poor. Our objective is to identify (1) QOL domains that are affected by treatment-related ototoxicity and (2) barriers to ototoxicity monitoring among survivors of H&N cancer to inform patient-centered interventions that reduce undiagnosed and untreated ototoxicity in survivorship.

METHODS

A qualitative study using semi-structured focus groups was conducted from March 2023 to September 2023 on survivors of H&N cancer treated with cisplatin-based CRT at a single tertiary care center. Inductive thematic analysis was used to identify themes related to the effect of ototoxicity on QOL and barriers to ototoxicity monitoring.

RESULTS

Seven focus groups ranging from 1 to 4 participants were conducted on 18 total participants (median age = 58 (range 45-67); 13 (72%) male; 16 (89%) white). Themes regarding ototoxicity and its effects on QOL included (1) social isolation, (2) emotional distress, (3) adaptive behaviors, and (4) that the impact is context-dependent. Themes regarding barriers to ototoxicity monitoring included (5) inconsistent referral to audiology; (6) the lack of patient education; (7) socioeconomic factors; and (8) hesitancy towards hearing aids.

CONCLUSIONS

Treatment-related ototoxicity has long-term implications for poorer QOL in H&N cancer survivorship. However, the negative impact of ototoxicity changes over time and depends on multiple patient-related factors.

IMPLICATIONS FOR CANCER SURVIVORS: Monitoring programs might seek to develop protocols to routinely screen H&N cancer survivors for ototoxicity and provide referrals and patient education material to improve audiologic follow-up. Such protocols may decrease rates of undiagnosed and untreated hearing loss in this patient population.