Treatment-induced hearing loss and adult social outcomes in survivors of childhood CNS and non-CNS solid tumors: Results from the St. Jude Lifetime Cohort Study.
BACKGROUND
Survivors of childhood cancer who are treated with platinum-based chemotherapy and/or cranial radiation are at risk of treatment-induced hearing loss. However, the effects of such hearing loss on adult social attainment have not been well elucidated.


METHODS
Adult survivors of pediatric central nervous system (CNS) solid tumors (180 survivors) and non-CNS solid tumors (226 survivors) who were treated with potentially ototoxic cancer therapy completed audiologic evaluations and questionnaires assessing their perception of social functioning and social attainment (ie, independent living, marriage, and employment). Audiograms were graded with the Chang ototoxicity grading scale. Analyses were stratified by tumor type (ie, CNS vs non-CNS). Multivariable logistic regression models were conducted with adjustment for age; sex; chronic health conditions; and, for the CNS group, IQ. Adjusted odds ratios (ORs) and 95% confidence intervals (95% CIs) were reported.


RESULTS
Serious hearing loss (that requiring a hearing aid or deafness) was detected in 36% of survivors of CNS tumors and 39% of survivors of non-CNS tumors. Serious hearing loss was associated with an increased risk of perceived negative impact in ≥1 areas of social functioning (survivors of non-CNS tumors: OR, 1.83 [95% CI, 1.00-3.34]). Among survivors of non-CNS tumors, serious hearing loss was associated with 2-fold increased risk of nonindependent living (OR, 2.19; 95% CI, 1.19-4.04) and unemployment or not graduating from high school (OR, 1.85; 95% CI, 1.00-3.34).


CONCLUSIONS
A substantial proportion of adult survivors of childhood cancer treated with potentially ototoxic therapy have serious hearing loss. Treatment-induced hearing loss was found to be associated with reduced social attainment, both perceived and actual, in this study sample.
Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee.
Tara M
TM
Brinkman
Department of Rehabilitation Services, St. Jude Children's Research Hospital, Memphis, Tennessee.
Johnnie K
JK
Bass
Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee.
Zhenghong
Z
Li
Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee.
Kirsten K
KK
Ness
Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee.
Amar
A
Gajjar
Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee.
Alberto S
AS
Pappo
Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee.|Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee.
Gregory T
GT
Armstrong
Department of Radiation Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee.
Thomas E
TE
Merchant
Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee.
Deo Kumar
DK
Srivastava
Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee.
Leslie L
LL
Robison
Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee.|Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee.
Melissa M
MM
Hudson
Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee.|School of Public Health, University of Memphis, Tennessee.
James G
JG
Gurney
D000293:Adolescent; D000328:Adult; D016543:Central Nervous System Neoplasms / Q000150:complications* / Q000401:mortality / Q000628:therapy; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D034381:Hearing Loss / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017741:Survivors
central nervous system solid tumors; childhood cancer; hearing loss; non-central nervous system solid tumors; social outcomes