Assessing quality of life in childhood cancer survivors at risk for hearing loss: a comparison of HEAR-QL and PROMIS measures

Anne Spence; Allison J L'Hotta; Susan S Hayashi; Kara Felts; Emily LaFentres; Megan Jones-White; Judith E C Lieu; Allison A King; Robert J Hayashi

doi:10.3389/fonc.2024.1362315

Assessing quality of life in childhood cancer survivors at risk for hearing loss: a comparison of HEAR-QL and PROMIS measures

Front Oncol. 2024 Mar 6:14:1362315. doi: 10.3389/fonc.2024.1362315. eCollection 2024.

Authors

Anne Spence¹, Allison J L'Hotta², Susan S Hayashi¹, Kara Felts¹, Emily LaFentres¹, Megan Jones-White¹, Judith E C Lieu³, Allison A King¹, Robert J Hayashi¹

Affiliations

¹ Department of Pediatrics, Division of Pediatric Hematology Oncology, Washington University in St. Louis, St. Louis, MO, United States.
² Brown School, Prevention Research Center, Washington University in St. Louis, St. Louis, MO, United States.
³ Department of Otolaryngology, Division of Pediatric Otolaryngology, Washington University in St. Louis, St. Louis, MO, United States.

Abstract

Background: Childhood cancer survivors (CCS) exposed to platinum chemotherapy are at an increased risk of developing hearing loss and reporting decreased quality of life (QOL). This study compared two QOL measures; one developed for children with hearing loss, The Hearing Environments and Refection on Quality of Life (HEAR-QL), and one validated in CCS, the Patient-Reported Outcomes Measurement Information System (PROMIS), to assess their ability to evaluate QOL deficits in this population.

Methods: Subject eligibility were restricted to CCS exposed to platinum-based chemotherapy but who were free of known risk factors for cognitive impairment, (non-central nervous system tumor, no cranial radiation, or intrathecal chemotherapy). Participants had to be between 8-17 years, have completed anti-cancer therapy for at least 6 months, and have an audiogram within 1 year, Participants completed the HEAR-QL-26 (7-12 years) or the HEAR-QL-28 (13-18 years) and the PROMIS. Independent samples and/or one sample T-tests were utilized to compare participants with normal hearing and hearing loss, and to compare outcome measures to normative HEAR-QL and PROMIS data. Non-parametric correlations were utilized to evaluate the relationship between QOL and demographic and medical variables, and QOL and severity of hearing loss.

Results: Fifty-four CCS were evaluable. The mean age was 12.0 years. Twenty-eight participants (51.9%) received cisplatin, 30 (55.6%) carboplatin, and 4 (7.4%) received both. Twenty participants (37%) demonstrated hearing loss. Participants with hearing loss scored significantly lower on the HEAR-QL than those with normal hearing (mean: 70.3, SD: 21.7, vs mean: 88.0, SD: 9.3, p =.004 for the HEAR-QL-26; mean: 84.7, SD: 10.2 vs mean: 94.8, SD: 3.4, p =.040 for the HEAR-QL-28). Participants with normal hearing scored significantly lower on the HEAR-QL-26 than the normative mean (mean: 88, SD: 9.3, normative mean: 98, SD: 5, p =.000). The PROMIS failed to identify any differences in QOL between participants based on hearing status, or when compared to the normative mean.

Conclusion: The HEAR-QL was more sensitive than the PROMIS in identifying QOL deficits in CCS at risk for hearing loss. The HEAR-QL should be considered in studies seeking to improve the QOL of CCS with hearing loss.

Keywords: HEAR-QL; PROMIS; QOL; childhood cancer survivor; hearing loss; ototoxicity.

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This study was supported by a grant through the St. Louis Children’s Hospital, Washington University School of Medicine, Children’s Discovery Institute (CDI, MC-II-2019-779 King, PI).