Provider Documentation of Tinnitus in Childhood Cancer Survivors

Abstract

Tinnitus is a known complication of treatment for childhood cancer and potentially reduces the quality of life for childhood cancer survivors (CCS). Although current guidelines recommend annual surveillance in CCS at risk for tinnitus, current screening practices among pediatric oncology survivorship providers are unknown. The authors performed a retrospective cohort study to assess the adequacy of current tinnitus screening in survivorship care. The 5.6% prevalence of tinnitus reported by the Childhood Cancer Survivorship Study, the largest ongoing follow-up cohort of CCS, served as the baseline for comparison for our rate of documented positive screening for tinnitus. Survivorship providers identified tinnitus in 3 of 624 (0.48%) eligible CCS, which was significantly lower than the prevalence in the Childhood Cancer Survivorship Study (P<0.0001). Survivorship providers documented any screening for tinnitus (positive or negative) in 15 of 624 (2.4%) CCS. Screening practices significantly differed by ototoxic exposure history and age at follow-up. This study demonstrates that screening and detection of tinnitus are underdocumented by survivorship providers, raising concern for inadequate screening practices. Improved screening may facilitate the recognition and treatment of this late effect, improving the quality of life for CCS.

Subjective and Objective Hearing Loss Among US Adult Cancer Survivors

“…Frisina et al found that the median time from chemotherapy to audiometry test was 4.3 years in high-risk cancer survivors who had received a cisplatin regimen for treatment of germ cell tumors, which suggests delayed screening and referral for HL. In another study assessing the tinnitus screening practice among childhood cancer survivors, only 3.8% of patients with prior ototoxic exposure were screened for tinnitus by their oncologists . Our study showed that 1 of 4 cancer survivors never had a hearing test in the past.…”

“…A recent work by Cheung et al included 273 adult cancer survivors of the 4 most common cancer types (breast, gastrointestinal, gynecologic, and lung) who received platinum and/or taxanes and found that more than 30% of cancer survivors had self-reported HL and more than 50% had audiometry-confirmed SFHL (median time since diagnosis ranged from 3.9 to 6.7 years). The reported prevalence of tinnitus was 3% to 60% among cancer survivors compared with 5% to 43% in the general population . In contrast to the prominent difference in younger individuals, we found a similar prevalence of self-reported tinnitus between cancer survivors and the general population among older individuals (age ≥65 years).…”