Protocol for a low-threshold screening program to detect hearing loss in childhood cancer survivors in Switzerland: The HEAR-study (Preprint)

BACKGROUND Hearing loss is a common late effect in childhood cancer survivors (CCS) caused by ototoxic cancer treatments, such as platinum chemotherapy, cranial radiation with doses of ≥ 30 Gray and surgery involving the auditory system. Early recognition of hearing loss as part of follow-up care allows for therapeutic support to mitigate consequences. However, hearing tests are usually only repeated in CCS with abnormal hearing during or right after treatment end, leaving hearing loss undetected in CCS with late onset or when missed during cancer treatment. Further, general follow-up care attendance may be low after CCS transition to adult care, contributing to missing hearing screening post-therapy. Low attendance may be attributed to CCS finding follow-up care burdensome and time-consuming, lacking awareness of their risk for certain late-effects, or the absence of suitable interdisciplinary follow-up clinics. OBJECTIVE The HEAR-study aimed to develop, conduct, and evaluate a low-threshold, community-based screening program for hearing loss in CCS, following a participatory research approach within the RE-AIM framework, a tool to plan and evaluate health interventions. METHODS We included CCS diagnosed with cancer between 1976-2019 before age 21 years who were ≥ 2 years post-diagnosis and registered in the Childhood Cancer Registry Switzerland (ChCR). We invited participants to receive standardized hearing assessment at a Swiss hearing aid provider. Results were handed out to CCS for discussion with their health care professional of choice. Participants completed a baseline questionnaire before the hearing test, and two follow-up questionnaires afterwards. We also invited a sub-sample of participants for semi-structured interviews. Questionnaires and interviews investigated experiences with and opinions about the screening program. We also interviewed hearing aid shop employees and will conduct a focus group interview with health-care professionals. We plan to evaluate the screening program based on the RE-AIM evaluation framework for community-based interventions. RESULTS This manuscript describes the protocol of the HEAR-study. As of June 2024, all participants have been recruited and all steps of the study up to the RE-AIM evaluation have been completed. The results will be evaluated based on the RE-AIM framework. CONCLUSIONS The HEAR-study introduces a novel, simple, and low-threshold approach to screen for hearing loss after cancer treatment through hearing aid shops located in the community and close to participants’ homes. This approach has the potential to supplement existing follow-up care programs by reducing the burden of hearing screening for adult CCS and reaching those who might otherwise be lost to follow-up. CLINICALTRIAL ClinicalTrials.gov “NCT06036407”