Pearson, Stephanie
(2022)
The ongoing effects and impact of hearing loss and tinnitus associated with platinum based chemotherapy in adults living with and beyond cancer.
PhD thesis, University of Nottingham.
Abstract
Many adults living with and beyond cancer (LWBC) are impacted by the multitude of toxicities associated with chemotherapy treatment. For example, platinum based chemotherapy (PBC) is known to cause ototoxicity, presenting as hearing loss and tinnitus. There is a paucity of good-quality information and support offered to patients who experience ototoxicity, which can subsequently lead to many being undiagnosed and untreated.
In order to identify gaps in the literature, a systematic review was carried out. The systematic review aimed to collect evidence about the prevalence and severity of chemo-therapy-induced hearing loss and tinnitus. However, no reliable prevalence, incidence or severity of ototoxicity was reported, though those with ototoxicity reported having a lower quality of life (QoL). To seek further information, grey literature in the form of online health forums was explored to identify what people experiencing ototoxicity were discussing with one another. The forum review gave a unique insight into online forums and people’s thoughts about ototoxicity and their experiences. Six major themes emerged from the forum review, including the nature of ototoxicity, time of experienced ototoxicity, information on ototoxicity, quality of life, therapies and online social support.
These two reviews then led to the development of two clinical studies: the first being a mixed method study identifying the severity and the impact of QoL in those living with the effects of ototoxicity. Results from the qualitative aspect found that more aware-ness is needed surrounding ototoxic effects and the impact this has on QoL, specifically, social QoL. Furthermore, experiences with clinicians have a major role in determining whether people receive guidance and support for their symptoms. Clinical staff that do not engage, refer or offer support can have a negative impact on the QoL of their patients, compared to those that listen and offer guidance. Second, a cross-sectional study was developed to identify the prevalence and severity of ototoxicity using ex-tended high-frequency audiometry in patients who received platinum based chemo-therapy. This study recruited 7 participants prior to being suspended due to COVID-19 research restrictions.
Finally, two online surveys were developed to identify acceptability of an ototoxicity monitoring programme for those undergoing chemotherapy. One survey was targeted at those who had received chemotherapy, the other was aimed at healthcare professionals specialising in hearing. The surveys showed that many people were unaware of ototoxicity as a side effect of chemotherapy, and that healthcare professionals such as ENTs and Audiologists did not unanimously agree on an ototoxicity monitoring proto-col, or which department is responsible for monitoring ototoxicity.
Ototoxicity is an understudied, yet important late effect of platinum based chemotherapy and more information, awareness and support is needed for adults living with and beyond cancer.
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