Evaluation of a new, community-based screening program to detect hearing loss in adult childhood cancer survivors in Switzerland: Findings from the HEAR study

Purpose: Childhood cancer survivors have an increased risk of long-term health complications, including treatment-related hearing loss. Although early detection is important, many adult survivors do not attend hearing screenings in clinical centers because visits can be logistically or emotionally burdensome. The HEAR study developed and tested an alternative, community-based audiological screening option in hearing aid shops in Switzerland. We evaluated the program and identified key considerations for possible routine implementation. Methods: We invited childhood cancer survivors (CCS) registered in the Childhood Cancer Registry and diagnosed with cancer before age 21 years to a free pure-tone audiogram at hearing aid shops across Switzerland. Participants completed a baseline questionnaire before the hearing test, and two follow-up questionnaires evaluating feasibility and user experience. We gathered qualitative insights through semistructured interviews with participants and hearing aid shop employees, and group discussions with healthcare professionals. Interviews were analyzed using thematic analysis, and group discussions using template analysis. We evaluated the program according to the RE-AIM framework, incorporating both quantitative and qualitative data. Results: Of 1604 invited CCS, 476 (30%) consented and 319 (20%) completed audiometric testing. We identified clinically relevant hearing loss in 71 participants (22%) using the SIOP-Boston ototoxicity scale. Following the screening, five participants chose to get hearing aids. Both CCS participants and clinicians were open to this alternative screening option and provided predominantly positive feedback. Together with clinicians, we developed an implementation plan that outlines how this screening option could be integrated into follow-up care. Conclusion: The feasible and accessible community-based screening option offered in the HEAR study could complement existing follow-up care, particularly for CCS who are no longer engaged in structured follow-up.