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

2.PurposeChildhood 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 tested an alternative, community-based audiological screening option 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. MethodsWe 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 semi structured 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. ResultsOf 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. Following the screening, five participants acquired 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. ConclusionThis simple and accessible community-based screening option could complement existing follow-up care, particularly for CCS who are no longer engaged in structured follow-up care.