Novel Prediction Model for Hearing Loss From Chemotherapy in Pediatric Patients With Cancer

In a study reported in the Journal of Clinical Oncology, Millstein et al attempted to develop a predictive model—Pediatric Holistic Evaluation of Auditory Risk (PedsHEAR)—for hearing loss associated with cisplatin chemotherapy in children and adolescents with cancer.

Study Details

PedsHEAR was developed from a multicenter training data set of cisplatin-exposed patients up to age 21 (1984–2017) and externally validated using data from the Children’s Oncology Group ACCL05C1 study (2007–2012) and two combined institutional cohorts (1988–2022). The model predicts the probability of hearing loss after treatment in each patient, with patients being classified as at low (< 0.33), intermediate (0.33–0.60), or high risk (> 0.60) for hearing loss. The primary outcome measure was post-treatment communication–affecting hearing loss—ie, International Society of Pediatric Oncology Ototoxicity Scale (SIOP) grade ≥ 2.

Key Findings

In the training data set (n = 1,115, median age = 6.3 years), SIOP grade ≥ 2 hearing loss was present in 44%. The PedsHEAR model showed high discrimination (AUC = 0.93, 95% confidence interval [CI] = 0.92–0.95). Discrimination was validated in an internal validation testing cohort (AUC = 0.79, 95% CI = 0.74–0.85) and two external validation cohorts (AUCs = 0.74 and 0.67). In an aggregate validation cohort (n = 631), the model predicted the probability of hearing loss (AUC = 0.76, 95% CI = 0.72–0.79) and classified 22% (n = 141), 71% (n = 447), and 7% (n = 43) of patients as at low, intermediate, and high risk for post-treatment hearing loss.

The investigators concluded: “PedsHEAR predicted SIOP grade ≥ 2 [hearing loss] in pediatric cisplatin-treated patients. This is the first validated model to successfully predict cisplatin-induced [hearing loss] in a broadly representative population treated with diverse regimens across a range of treatment settings.”

Etan Orgel, MD, MS, of Keck School of Medicine, University of Southern California, Los Angeles, is the corresponding author of the Journal of Clinical Oncology article.