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What Factors are Associated with Hearing Loss in Childhood Cancer Survivors Treated with Platinum Agents?

GregoryAuneby Gregory Aune, MD, PhD, CKN Editor


Childhood Cancer Survivors have their own unique set of issues that often go unaddressed by health care professionals once treatment has ended and the child enters adulthood.  Although the last 20 years have seen growth in survivorship research, this research is rarely filtered down to the people who need it most – the survivors and their families.  Dr. Gregory Aune, Pediatric Oncologist, researcher, childhood cancer survivor and advocate, has taken on the position of CKN Editor, Knowledge Translation – Childhood Cancer Survivorship.  His goal is simple:  to help empower childhood cancer survivors to start a dialogue with their doctors by publishing short, easy-to-read research study summaries, like this one.




THE HEADLINE:  Identifying factors associated with platinum-induced ototoxicity in pediatric cancer survivors.


THE RESEARCH:  Determinants of ototoxicity in 451 platinum-treated Dutch survivors of childhood cancer:  A DCOG late-effects study.  Researchers compiled treatment data and audiograms from 451 childhood cancer survivors (CCS) treated at seven pediatric oncology centers in the Netherlands.  The study focused on identifying patients that had received platinum agents without cranial irradiation, since no previous studies have looked at ototoxicity outcomes in this population.  Risk factors evaluated for the development of hearing impairment included the impact of co-medications, type of platinum agent (cisplatin or carboplatin), and cumulative dose received.


KEY FINDINGS:  In the cohort identified, the overall frequency of ototoxicity was 42%.  In cisplatin-treated CCS, ototoxicity was observed in 45% of patients, while those CCS treated with carboplatin developed hearing impairment at a frequency of 17%.  The frequency of ototoxicity was highest in CCS who received both cisplatin and carboplatin.  75% of these individuals developed hearing problems.  Factors identified that increased the risk of developing hearing impairment included younger age at diagnosis, co-treatment with lasix (a diuretic), and cumulative dose of platinum agents.


WHAT THIS MEANS FOR CHILDHOOD CANCER SURVIVORS:  Platinum agents are effective chemotherapy agents frequently used in the treatment of brain tumors, germ cell tumors, osteosarcoma, and retinoblastoma   The association between platinum exposure and hearing problems has been previously established.  However, almost all prior studies included large numbers of patients that had received both platinum agents and cranial radiation (mostly brain tumor patients).  A major goal of this study was to identify the risks for developing hearing problems in survivors who had received platinum agents as part of their therapy, but no cranial radiation.  The investigators noted that age of platinum exposure increased the risk for hearing problems, which is possibly explained by recent lab research that cells in younger patients are more sensitive to chemotherapy-induced damage.  Historically, cisplatin has been considered the more ototoxic platinum agent and this study did verify that hearing impairment is more frequent in CCS treated with cisplatin than in those treated with carboplatin only.  However, the frequency of hearing impairment in those patients was still almost one in five.  Thus, it is important for CCS to have periodic hearing evaluations regardless of platinum agent received.  In addition, CCS should know the cumulative dose of platinum agents they received, because a higher cumulative dose was associated with a higher risk of hearing impairment.  Finally, an important finding in this study was that CCS who received the diuretic lasix along with platinum agents also had a higher frequency of hearing problems.  All survivors that received platinum agents should undergo periodic hearing evaluations and talk with their doctor about these newly identified factors that increase the risk for hearing impairment.



Medical Disclaimer:  The information on this site is not intended or implied to be a substitute for professional medical advice, diagnosis or treatment. All content, including text, graphics, images and information, contained on or available through this web site is for general information purposes only.  If you feel the research summarized applies to you or someone you know, talk to your doctor about your concerns.



Videos with Dr. Aune

Presentation on YouTube (Jan 2015):  Eliminating Long-term Health Effects in Cancer Survivors – Gregory Aune, MD, PhD

Interview for the National Coalition for Cancer Survivorship (June 2015):  Hodgkin’s Lymphoma Survivor Dr. Greg Aune Discusses Issues in Long-Term Survivorship Care

Interview with the Washington Post Live Summit (Dec 2016): How cancer lives on in young adults after treatment ends



Dr. Gregory J. Aune is the Stephanie Edlund Distinguished Professor of Pediatric Cancer Research and a St. Baldrick’s Foundation Scholar.  His experience in pediatric cancer spans over 27 years and encompasses his own patient experiences, research in experimental therapeutics, clinical care of pediatric oncology patients, and childhood cancer advocacy.  His interest in pediatric oncology began at age 16, when he was diagnosed with Hodgkin’s lymphoma.  While fortunate to survive, the experiences he encountered as a patient initiated a path towards a research and clinical career aimed at developing less toxic chemotherapy regimens.  His experience as a long-term survivor included open-heart surgery at age 35 to replace his aortic valve and bypass three blocked coronary arteries that were damaged by his teenage cancer therapies.  This life-changing event initiated his research interest in cardiac disease.  His training to become a successful physician scientist and pediatric oncologist has included time spent at some of the most well-respected oncology institutions in the United States including, M.D. Anderson Cancer Center, the National Cancer Institute, and Johns Hopkins Hospital.

Dr. Aune is a national leader in childhood cancer advocacy efforts.  In San Antonio, he has been a leader in local fundraising and awareness efforts.   Since 2010, he has spearheaded efforts by the St. Baldrick’s Foundation and For the Kids Dance Marathon at the University of Texas San Antonio that have raised over $830,000 for childhood cancer patients and research efforts.  In September 2014, his appointment to the National Cancer Institute Council of Research Advocates (NCRA) was announced by NCI Director Dr. Harold Varmus at a White House briefing on childhood cancer.

In addition, Dr. Aune is a policy advisor for the National Coalition for Cancer Survivorship, serves on the Board of Directors of the American Childhood Cancer Organization, is a member of the St. Baldrick’s Foundation National Advocacy Committee, and serves on the scientific advisory board for the Canines-N-Kids foundation.

In May 2015, Dr. Aune addressed the 68th World Health Assembly in Geneva, Switzerland and called on the World Health Organization to make childhood cancer a top global health priority.



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