When surviving cancer leaves you hard of hearing

That’s just one of the side effects of chemo that can make life tough ... even when the worst is over

After being told she had bone cancer, florencia Pistritto’s mind was focused on one thing: survival. ‘I just couldn’t stop crying,’ says florencia, 31, a former waitress from edinburgh. ‘All I could think about was my two-year-old son Marco.’

So when she was told the chemotherapy she needed might leave her with long-term side-effects, this barely registered.

florencia had a 10cm tumour in her thigh. ‘My doctors said it was touch and go whether they could save my leg, but said it was possible to cure me with chemotherapy and surgery,’ she says.

Over the next ten months, florencia was given 17 cycles of cisplatin, a widely used form of chemotherapy.

‘Before I started on cisplatin I was warned it might cause hearing loss and was given a hearing test,’ she says, two years on.

‘But when you have a two-year-old and are trying to stay alive, you tend not to worry so much about your hearing.’

However, after her first chemo session in July 2014, she noticed a ringing noise in her ears. ‘ And when Marco was shouting his voice sounded muffled,’ she says.

‘I didn’t want to lose my hearing at 29, but I had little choice as the doctors said cisplatin was the most effective drug for my cancer.’

After five cycles of chemotherapy, she needed hearing aids in both ears. for florencia, who speaks fluent Italian and who had hoped to start a career as a translator once her treatment was completed, it was worrying.

Cisplatin is given to 25 per cent of cancer patients, and while it is effective at destroying cancer cells, it may also damage the tiny hairs inside the ear that are crucial for hearing.

Around 60 per cent of patients who receive the drug will develop hearing loss. the higher the dose and more courses of chemotherapy, the worse the damage.

Cisplastin contains platinum, a heavy metal that’s very effective against cancer.

But it’s not just hearing loss. florencia, like many who have cisplastin and other forms of chemotherapy, suffers from socalled ‘ chemo brain’, characterised by problems concentrating and fatigue.

Striking a balance between the need to eradicate cancer cells with maintaining quality of life after treatment is difficult.

It is a growing challenge: advances in treatment mean more people than ever are surviving cancer, according to a report published yesterday by the charity Macmillan Cancer Support, but around a quarter are left facing some kind of poor health or disability.

Many have been affected by the side-effects of cancer treatment.

Onestudy just published in the journal Cancer found that one in five women over 65 with newly diagnosed breast cancer had lost the ability to complete some of the basic tasks necessary for independent living within one year of starting treatment as a result of the treatment itself.

It’s not just chemotherapy that can cause long-term issues.

A study published in JAMA Internal Medicine showed that women who have had radiotherapy for breast cancer had up to a 4 per cent greater risk of heart attack — radiation is linked to coronary artery disease, cardiomyopathy (disease of the heart muscle) and heart valve disease. Hundreds of thousands of people in the UK are living with ill health or disability due to their cancer treatment, says Macmillan Cancer Support.

Problems include chronic fatigue, sexual difficulties, mental health issues, incontinence and gastro- intestinal problems.

Professor Jane Maher, a consultant oncologist at Mount Vernon Cancer Centre, Hillingdon, West London, says some problems may only emerge months after treatment and can persist for ten years or more.

‘Health problems related to cancer treatment can under-recognised and under-treated,’ she says.

‘Patients often don’t connect their symptoms to the cancer treatment, especially if they start after treatment has ended. they may develop poor bowel control more than a year after pelvic radiotherapy, for example, while those treated with chemotherapy and radiotherapy as children may develop heart failure during labour due to damage to the heart.

‘Others suffer from “chemo-brain”: fatigue is common in the first year after treatment, which can make returning to work hard.’

But as more people live many years after treatment, attention is turning to trying to ensure those years are not mired by the treatment’s effects.

the charity Action On Hearing Loss has announced a research grant to investigate how chemotherapy drugs cause the irreparable damage to the hair cells in the ear.

‘ Cisplatin is a gold standard treatment for solid tumours and is incredibly effective, but it can cause profound hearing loss,’ says Dr ralph Holme, the charity’s director of biomedical research.

‘Our research is going to focus on understanding how cisplatin gets into the hair cells and then we’ll be screening a number of existing compounds to see if they can protect against this.’

Switching treatments may help prevent some long-term effects, says Dr timothy Yap, a clinician scientist at the Institute Of Cancer research, London, and consultant medical oncologist at the royal Marsden Hospital, London.

‘We make sure patients are aware hearing loss is a possible long-term side-effect of cisplatin and tell them they should inform their oncologist if they notice any changes in their hearing,’ he says.

‘even before tinnitus is obvious they may notice a buzzing sound or whooshing noise, so they can be switched to another type of chemotherapy, such as carboplatin, which has a much lower risk of hearing problems, before the damage becomes too widespread.’

Carboplatin also contains platinum, but is not as effective as cisplastin.

Another option is to personalise the treatment using drugs targeted at the patient’s specific cancer.

Dr Yap treats selected lung cancer patients with targeted drugs called epidermal growth factor receptor (eGfr) inhibitors, such as tarceva, Iressa and Afatinib.

‘these act like homing missiles against specific cancer targets, in this case eGfr, rather than proving toxic against all cells,’ he says.

‘Patients are screened to detect if they have an eGfr mutation in their cancer, so oncologists can predict whether these targeted drugs will work for them.’

Also being introduced are genetic tests that can identify patients who won’t respond to breast cancer chemotherapy, for example, so they can avoid side- effects from treatments that wouldn’t have helped them.

THenational Institute of Healthcare and excellence (nICe) updated guidance in June to recommend patients are given a new genetic test called Oncotype DX, which can predict which women with certain types of early stage breast cancer will respond to chemotherapy.

If chemotherapy is unsuitable after surgery, radiotherapy or hormone treatments may be used.

Strategies are being introduced to minimise some of the debilitating side-effects of radiotherapy, too.

‘there are also simple breathholding exercises for people to do during radiotherapy so their heart is kept away from the chest wall and less likely to be damaged by the treatment,’ says Professor Maher.

It’s hoped that in the future cancer patients may avoid the long-term effects florencia has suffered. Her hearing is so limited she will not be able to work as a translator.

‘I’m grateful to have had such effective treatment, but now there are two million cancer survivors in the UK, there has to be more emphasis on what our quality of life will be like after treatment.’