Evaluation of a New, Community-Based Screening Program to Detect Hearing Loss in Adult Childhood Cancer Survivors in Switzerland: Findings From the HEAR Study.

Background Childhood cancer survivors (CCS) 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 tested an alternative, community-based audiological screening delivered in hearing aid shops in Switzerland. We evaluated its effectiveness, including clinical outcomes and survivor engagement, and developed a plan for potential implementation in clinical practice.Methods Adult CCS registered in the Childhood Cancer Registry and diagnosed before age 21 were invited to a free pure-tone audiogram at hearing aid shops across Switzerland. Participants completed a baseline questionnaire before testing 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. 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. The program identified clinically relevant hearing loss in 71 participants (22%) using the SIOP-Boston ototoxicity scale. Five participants acquired hearing aids. Both CCS and clinicians were open to this alternative screening option and provided predominantly positive feedback. Together with clinicians, we developed an implementation plan detailing how this screening could be integrated into follow-up care.Conclusion This simple, accessible community-based screening option could complement existing follow-up care, particularly for CCS who are no longer engaged in structured follow-up care.