Date Presented 04/13/21
Children with cancer treated with platinum-based chemotherapy are at risk for developing hearing impairment (HI), one of several late effects associated with treatment. HI is associated with decreased socioemotional development, academic performance, and quality of life (QOL) among survivors of central nervous system (CNS) tumors. This is the first study to examine the impact of ototoxic HI on cognition and QOL among a cohort of survivors of pediatric non-CNS cancers.
Primary Author and Speaker: Taniya Easow Varughese
Contributing Authors: Julia Ferringer, Emily Grambo, Hannah Murkens, Jillian Smith, and Emily Scifo
PURPOSE: Each year more than 15,000 children and adolescents under the age of 19 are diagnosed with cancer in the United States. As a result of advancements in cancer therapies and treatments over the past 5 decades, the 5-year survival rate for children with cancer currently exceeds 80%. Multimodal treatments, including platinum-based chemotherapy agents such as cisplatin and carboplatin, have largely contributed to increased survivorship. However, the use of these agents is associated with the development of severe late effects, including sensorineural hearing impairment (HI). Speech and language acquisition, mental health, socio-emotional development, academic performance, and quality of life (QOL) can be negatively impacted by HI. Although the effects of HI have been well studied in survivors of central nervous system (CNS) cancers, little research exists on the impact of ototoxic HI on survivors of non-CNS tumors. The purpose of this study was to examine the effect of ototoxic HI on cognition and QOL among non-CNS pediatric cancer survivors.
DESIGN: We used a prospective, cross-sectional design with a non-random sampling method. Eligible patients (> 8 years of age, diagnosed with a pediatric non-CNS tumor, treated with ototoxic chemotherapy, no radiation exposure to the head, and out of treatment for at least 6 months) were recruited during routine outpatient oncology visits at St. Louis Children’s Hospital.
METHOD: Enrolled participants completed the National Institutes of Health Toolbox Cognition Battery (NIHTBCB) and the Hearing Environments and Reflection on QOL (HEAR-QL). Participants were stratified into two groups-those with HI and those with normal hearing. Participants' mean scores were compared to normative samples.
RESULTS: Twenty-nine individuals completed study procedures. Mean age was 12.1 (range 8-17; SD 2.8) and 15 were female (52%). Mean age at diagnosis was 4.4 (range 0.3-15.1; SD 4.3), and over half were diagnosed with neuroblastoma (37.9%) or germ cell tumor (27.6%). Nine (31%) had sensorineural HI. As a whole, survivors scored significantly lower than the normative population on measures of attention (mean difference [MD] 10.8; p < .001), executive function (MD 5.1; p = .005), and overall fluid (MD 6.8; p = .003) and composite cognition (MD 6.2; p = .002). No differences were observed in cognition between patients with HI and those without. Younger patients (between ages 8-12) reported worse QOL than the normative sample on the HEAR-QL (MD 17.6; p = .003). Younger patients with HI scored significantly lower than those with normal hearing on the Environment subscale of the HEAR-QL (MD 33.5; p = .003) indicating increased difficulty with hearing in various situations including play, restaurants, classroom, and interacting with family and friends.
CONCLUSION: Regardless of HI, survivors of pediatric non-CNS cancers demonstrate marked deficits in cognition indicating that all survivors would benefit from early identification of needs and referral to occupational therapy (OT) for cognitive rehabilitation and strategy training. Younger survivors with HI are at risk for experiencing increased difficulty in social and school engagement affecting their QOL. OT interventions designed to mitigate barriers may prove especially beneficial in improving participation and QOL among younger survivors with HI.
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