Association of hearing loss with patient-reported functional outcomes in adult survivors of childhood cancer

Background

Hearing loss (HL) is prevalent following ototoxic therapy for childhood cancer. Associations between HL, self-perceived hearing handicap, and functional outcomes have not been examined in survivors.

Methods

Adult survivors treated with platinum or head/neck radiotherapy with HL were recruited. Two hundred thirty-seven survivors (median[range] age at survey 37.0[30.0-45.0] years, 29.1[22.4-35.0] years since diagnosis, 4.0[2.9-7.7] years from last audiogram to survey) completed the Hearing Handicap Inventory for Adults and questionnaires on social and emotional functioning and hearing aid (HA) use. Hearing loss severity was defined according to Chang criteria. Multivariable logistic regression models estimated odds ratios (OR) and 95% confidence intervals (CI) for associations between HL, hearing handicap, functional outcomes, and HA use with adjustment for sex, race, age at HL diagnosis, and age at survey.

Results

Two-thirds of survivors had severe HL, which was associated with increased likelihood of hearing handicap (mild-moderate handicap: OR = 2.72, CI 1.35-5.47; severe handicap: OR = 5.99, CI 2.72-13.18). Survivors with severe hearing handicap had increased likelihood of social isolation (OR = 8.76, CI 3.62-21.20), depression (OR = 9.11, CI 3.46-24.02), anxiety (OR = 17.57, CI 3.77-81.84), reduced personal income (OR = 2.82, CI 1.46-5.43), and less than full-time employment (OR = 2.47, CI 1.30-4.70). Survivors who did not use a recommended HA were twice as likely to have less than full-time employment (OR = 2.26, CI 1.10-4.61) and reduced personal income (OR = 2.24, CI 1.08-4.63) compared to survivors who wore a HA.

Conclusion

Self-perceived hearing handicap beyond measured HL is associated with reduced functional outcomes. Assessment of hearing handicap may facilitate targeted interventions in adult survivors with HL.