Jörger Philippa, Nigg Carina, Mader Luzius, Strebel Sven, Kompis Martin, Tomášiková Zuzana, Schindera Christina, Michel Gisela, von der Weid Nicolas Xavier, Ansari Marc, Waespe Nicolas, Kuehni Claudia Elisabeth
Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
Graduate School for Health Sciences, University of Bern, Bern, Switzerland.
JMIR Res Protoc. 2025 May 21;14:e63627. doi: 10.2196/63627.
Hearing loss is a common late effect in childhood cancer survivors, 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 childhood cancer survivors with abnormal hearing during or right after treatment ends, leaving hearing loss undetected in childhood cancer survivors with late onset or when missed during cancer treatment. Further, general follow-up care attendance may be low after childhood cancer survivors transition to adult care, contributing to missing hearing screening posttherapy. Low attendance may be attributed to childhood cancer survivors 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. A low-threshold, easily accessible screening program requiring minimal participant effort may address these barriers and improve access to hearing loss screening for childhood cancer survivors.
The HEAR study aims to develop, conduct, and evaluate the feasibility of a low-threshold, community-based screening program for hearing loss in childhood cancer survivors, using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework, a tool to plan and evaluate health interventions. Within the screening program, participating childhood cancer survivors completed a standardized hearing assessment at a local Swiss hearing aid provider's shop. This approach provides low-threshold access to detect hearing loss as it is easily and conveniently accessible for everyone.
Eligible childhood cancer survivors were identified through the Childhood Cancer Registry Switzerland and included those diagnosed with cancer between 1976 and 2019 before 21 years and who were ≥2 years post diagnosis. We invited eligible childhood cancer survivors by post. Participants scheduled a hearing test appointment at a hearing aid shop. They completed a baseline questionnaire before the hearing test, and 2 follow-up questionnaires afterward to assess program feasibility and participant experiences. Semistructured interviews with participants, hearing aid shop staff, and group discussions with health care professionals will provide qualitative insights. The RE-AIM framework will guide the program evaluation using the quantitative and qualitative data collected.
As of February 2025, all participants have been recruited, and all steps of the study up to the group discussions and the RE-AIM evaluation have been completed.
The HEAR study introduces a novel, simple, and low-threshold approach to screening 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 childhood cancer survivors and reaching those who might otherwise be lost to follow-up.
ClinicalTrials.gov NCT06036407; https://clinicaltrials.gov/study/NCT06036407.
INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/63627.
听力损失是儿童癌症幸存者常见的晚期效应，由耳毒性癌症治疗引起，如铂类化疗、剂量≥30格雷的颅脑放疗以及涉及听觉系统的手术。作为后续护理的一部分，早期识别听力损失有助于提供治疗支持以减轻后果。然而，听力测试通常仅在治疗期间或结束后听力异常的儿童癌症幸存者中重复进行，导致迟发性听力损失的儿童癌症幸存者或在癌症治疗期间未被检测出听力损失的情况未被发现。此外，儿童癌症幸存者过渡到成人护理后，一般后续护理的参与率可能较低，导致治疗后听力筛查缺失。参与率低可能归因于儿童癌症幸存者认为后续护理繁重且耗时、对某些晚期效应的风险缺乏认识，或缺乏合适的跨学科后续诊所。一个低门槛、易于获得且参与者工作量最小的筛查项目可能会消除这些障碍，并改善儿童癌症幸存者获得听力损失筛查的机会。
HEAR研究旨在使用“覆盖、效果、采用、实施和维持”（RE-AIM）框架（一种规划和评估健康干预措施的工具），开发、实施并评估一项针对儿童癌症幸存者听力损失的低门槛、基于社区的筛查项目。在筛查项目中，参与的儿童癌症幸存者在瑞士当地一家助听器供应商的店铺完成了标准化听力评估。这种方法提供了低门槛的途径来检测听力损失，因为对每个人来说都很容易且方便获得。
通过瑞士儿童癌症登记处识别符合条件的儿童癌症幸存者，包括那些在1976年至2019年21岁之前被诊断患有癌症且诊断后已满2年的患者。我们通过邮寄方式邀请符合条件的儿童癌症幸存者。参与者在一家助听器店预约听力测试。他们在听力测试前完成一份基线问卷，并在之后完成两份随访问卷，以评估项目的可行性和参与者的体验。对参与者、助听器店工作人员进行半结构化访谈以及与医疗保健专业人员进行小组讨论将提供定性见解。RE-AIM框架将指导使用所收集的定量和定性数据进行项目评估。
截至2025年2月，所有参与者均已招募完成，并且研究直至小组讨论和RE-AIM评估的所有步骤均已完成。
HEAR研究引入了一种新颖、简单且低门槛的方法，通过位于社区且靠近参与者住所的助听器店对癌症治疗后的听力损失进行筛查。这种方法有可能通过减轻成年儿童癌症幸存者的听力筛查负担并覆盖那些否则可能失去随访的人群，来补充现有的后续护理项目。
ClinicalTrials.gov NCT06036407；https://clinicaltrials.gov/study/NCT06036407。
国际注册报告识别码（IRRID）：DERR1-10.2196/63627。
