A Health Service Research Study on a Low-Threshold Hearing Screening Program for Childhood Cancer Survivors in Switzerland: Protocol for the HEAR Study.
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BACKGROUND: 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. OBJECTIVE: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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. TRIAL REGISTRATION: ClinicalTrials.gov NCT06036407; https://clinicaltrials.gov/study/NCT06036407. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/63627.