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.