Hearing loss and quality of life in survivors of paediatric CNS tumours and other cancers



Hearing loss, a complication of cancer treatment, may reduce health-related quality of life (HRQoL), especially in childhood cancer survivors of central nervous system (CNS) tumours who often have multiple late effects. We examined the effect of hearing loss on HRQoL in young survivors of CNS and other childhood cancers.


Within the Swiss Childhood Cancer Survivor Study, we sent questionnaires about hearing loss and HRQoL (KIDSCREEN-27) to parents of survivors aged 8–15 years. We stratified the effect of hearing loss on HRQoL by cancer diagnosis, using multivariable logistic regression and adjusting for sociodemographic and clinical factors.


Hearing loss was associated with impaired physical well-being [unadjusted estimated differences − 4.6 (CI − 9.2, − 0.1); adjusted − 4.0 (CI − 7.6, − 0.3)] and peers and social support [unadjusted − 6.7 (CI − 13.0, − 0.3); adjusted − 5.0 (CI − 10.5, 0.9)] scores in survivors of CNS tumours (n = 123), but not in children diagnosed with other cancers (all p-values > 0.20, n = 577).


Clinicians should be alert to signs of reduced physical well-being and impaired relationships with peers. Especially survivors of CNS tumours may benefit most from strict audiological monitoring and timely intervention to mitigate secondary consequences of hearing loss on HRQoL.

This is a preview of subscription content, log in to check access.

Fig. 1


  1. 1.

    Landier, W. (2016). Ototoxicity and cancer therapy. Cancer, 122(11), 1647–1658. https://doi.org/10.1002/cncr.29779.

    Article  PubMed  Google Scholar 

  2. 2.

    Roland, L., Fischer, C., Tran, K., Rachakonda, T., Kallogjeri, D., & Lieu, J. (2016). Quality of life in children with hearing impairment: Systematic review and meta-analysis. Otolaryngol Head Neck Surg. https://doi.org/10.1177/0194599816640485.

    Article  PubMed  PubMed Central  Google Scholar 

  3. 3.

    Lin, C.-Y., & Fung, X. (2018). The impact of environmental support on health for children with hearing impairment in Taiwan. Social Health and Behavior, 1(1), 4–10. https://doi.org/10.4103/shb.shb_12_18.

    Article  Google Scholar 

  4. 4.

    Gurney, J. G., Tersak, J. M., Ness, K. K., Landier, W., Matthay, K. K., Schmidt, M. L., et al. (2007). Hearing loss, quality of life, and academic problems in long-term neuroblastoma survivors: A report from the Children’s Oncology Group. [Comparative Study Research Support, N.IH., Extramural Research Support, Non-U.S. Gov’t]. Pediatrics, 120(5), e1229–e1236. https://doi.org/10.1542/peds.2007-0178. [).

    Article  PubMed  Google Scholar 

  5. 5.

    Wengenroth, L., Gianinazzi, M. E., Rueegg, C. S., Luer, S., Bergstraesser, E., Kuehni, C. E., et al. (2015). Health-related quality of life in young survivors of childhood cancer. Quality of Life Research, 24(9), 2151–2161. https://doi.org/10.1007/s11136-015-0961-3.

    Article  CAS  PubMed  Google Scholar 

  6. 6.

    Laverdiere, C., Cheung, N. K., Kushner, B. H., Kramer, K., Modak, S., LaQuaglia, M. P., et al. (2005). Long-term complications in survivors of advanced stage neuroblastoma. Pediatric Blood and Cancer, 45(3), 324–332. https://doi.org/10.1002/pbc.20331.

    Article  PubMed  Google Scholar 

  7. 7.

    Portwine, C., Rae, C., Davis, J., Teira, P., Schechter, T., Lewis, V., et al. (2016). Health-related quality of life in survivors of high-risk neuroblastoma after stem cell transplant: A national population-based perspective. Pediatric Blood and Cancer, 63(9), 1615–1621. https://doi.org/10.1002/pbc.26063.

    Article  PubMed  Google Scholar 

  8. 8.

    Weiss, A., Kuonen, R., Brockmeier, H., Grotzer, M., Candreia, C., Maire, R., et al. (2018). Audiological monitoring in Swiss childhood cancer patients. Pediatric Blood and Cancer. https://doi.org/10.1002/pbc.26877.

    Article  PubMed  Google Scholar 

  9. 9.

    Children’s Oncology Group (2013). Long-Term Follow-Up Guidelines for Survivors of Childhood, Adolescent and Young Adult Cancers, Version 4.0. http://www.survivorshipguidelines.org.

  10. 10.

    Kuehni, C. E., Rueegg, C. S., Michel, G., Rebholz, C. E., Strippoli, M. P., Niggli, F. K., et al. (2012). Cohort profile: The Swiss childhood cancer survivor study [Research Support, Non-U.S. Gov’t]. International Journal of Epidemiology, 41(6), 1553–1564, https://doi.org/10.1093/ije/dyr142.

    Article  PubMed  Google Scholar 

  11. 11.

    Michel, G., von der Weid, N. X., Zwahlen, M., Adam, M., Rebholz, C. E., Kuehni, C. E., et al. (2007). The Swiss Childhood Cancer Registry: Rationale, organisation and results for the years 2001–2005. [Research Support, Non-U.S Gov’t]. Swiss Medical Weekly, 137(35–36), 502–509.

    PubMed  Google Scholar 

  12. 12.

    Schindler, M., Mitter, V., Bergstraesser, E., Gumy-Pause, F., Michel, G., & Kuehni, C. E. (2015). Death certificate notifications in the Swiss Childhood Cancer Registry: Assessing completeness and registration procedures. Swiss Medical Weekly, 145, w14225. https://doi.org/10.4414/smw.2015.14225.

    Article  PubMed  Google Scholar 

  13. 13.

    Ravens-Sieberer, U., & Europe, K. G. (2006). The Kidscreen questionnaires: Quality of life questionnaires for children and adolescents; handbook. Lengerich: Pabst Science Publ.

    Google Scholar 

  14. 14.

    Ravens-Sieberer, U., Auquier, P., Erhart, M., Gosch, A., Rajmil, L., Bruil, J., et al. (2007). The KIDSCREEN-27 quality of life measure for children and adolescents: Psychometric results from a cross-cultural survey in 13 European countries. Quality of Life Research, 16(8), 1347–1356. https://doi.org/10.1007/s11136-007-9240-2.

    Article  PubMed  Google Scholar 

  15. 15.

    Jervaeus, A., Kottorp, A., & Wettergren, L. (2013). Psychometric properties of KIDSCREEN-27 among childhood cancer survivors and age matched peers: A Rasch analysis. Health and Quality of Life Outcomes, 11, 96. https://doi.org/10.1186/1477-7525-11-96.

    Article  PubMed  PubMed Central  Google Scholar 

  16. 16.

    Jervaeus, A., Lampic, C., Johansson, E., Malmros, J., & Wettergren, L. (2014). Clinical significance in self-rated HRQoL among survivors after childhood cancer—Demonstrated by anchor-based thresholds. Acta Oncology, 53(4), 486–492. https://doi.org/10.3109/0284186x.2013.844852.

    Article  Google Scholar 

  17. 17.

    Bisegger, C., Cloetta, B., & Europe Kidscreen Group (2005). Kidscreen: Fragebogen zur Erfassung der gesundheitsbezogenen Lebensqualität von Kindern und Jugendlichen. Manual der deutschsprachigen Versionen für die Schweiz. Bern: Universität Bern, Abteilung Gesundheitsforschung des Instituts für Sozial- und Präventivmedizin.

    Google Scholar 

  18. 18.

    Steliarova-Foucher, E., Stiller, C., Lacour, B., & Kaatsch, P. (2005). International Classification of Childhood Cancer, third edition. [Research Support, Non-U.S. Gov’t]. Cancer, 103(7), 1457–1467. https://doi.org/10.1002/cncr.20910.

    Article  PubMed  Google Scholar 

  19. 19.

    Fuemmeler, B. F., Elkin, T. D., & Mullins, L. L. (2002). Survivors of childhood brain tumors: Behavioral, emotional, and social adjustment. Clinical Psychology Review, 22(4), 547–585.

    Article  PubMed  Google Scholar 

  20. 20.

    Hocking, M. C., McCurdy, M., Turner, E., Kazak, A. E., Noll, R. B., Phillips, P., et al. (2015). Social competence in pediatric brain tumor survivors: Application of a model from social neuroscience and developmental psychology. Pediatric Blood & Cancer, 62(3), 375–384. https://doi.org/10.1002/pbc.25300.

    Article  Google Scholar 

  21. 21.

    Schulte, F., Wurz, A., Reynolds, K., Strother, D., & Dewey, D. (2016). Quality of life in survivors of pediatric cancer and their siblings: The consensus between parent-proxy and self-reports. Pediatric Blood & Cancer, 63(4), 677–683. https://doi.org/10.1002/pbc.25868.

    Article  Google Scholar 

  22. 22.

    van Dijk, J., Huisman, J., Moll, A. C., Schouten-van Meeteren, A. Y., Bezemer, P. D., Ringens, P. J., et al. (2007). Health-related quality of life of child and adolescent retinoblastoma survivors in the Netherlands. Health and Quality Life Outcomes, 5, 65. https://doi.org/10.1186/1477-7525-5-65.

    Article  Google Scholar 

  23. 23.

    Matziou, V., Perdikaris, P., Feloni, D., Moschovi, M., Tsoumakas, K., & Merkouris, A. (2008). Cancer in childhood: Children’s and parents’ aspects for quality of life. European Journal of Oncology Nursing, 12(3), 209–216. https://doi.org/10.1016/j.ejon.2007.10.005.

    Article  PubMed  Google Scholar 

  24. 24.

    Laffond, C., Dellatolas, G., Alapetite, C., Puget, S., Grill, J., Habrand, J. L., et al. (2012). Quality-of-life, mood and executive functioning after childhood craniopharyngioma treated with surgery and proton beam therapy. Brain Injury, 26(3), 270–281. https://doi.org/10.3109/02699052.2011.648709.

    Article  CAS  PubMed  Google Scholar 

  25. 25.

    Weiss, A., Sommer, G., Kuonen, R., Scheinemann, K., Grotzer, M., Kompis, M., et al. (2017). Validation of questionnaire-reported hearing with medical records: A report from the Swiss Childhood Cancer Survivor Study. PLoS ONE, 12(3), e0174479. https://doi.org/10.1371/journal.pone.0174479.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. 26.

    Louie, A. D., Robison, L. L., Bogue, M., Hyde, S., Forman, S. J., & Bhatia, S. (2000). Validation of self-reported complications by bone marrow transplantation survivors. Bone Marrow Transplant, 25(11), 1191–1196. https://doi.org/10.1038/sj.bmt.1702419.

    Article  CAS  PubMed  Google Scholar 

  27. 27.

    Brinkman, T. M., Bass, J. K., Li, Z., Ness, K. K., Gajjar, A., Pappo, A. S., et al. (2015). Treatment-induced hearing loss and adult social outcomes in survivors of childhood CNS and non-CNS solid tumors: Results from the St. Jude Lifetime Cohort Study. Cancer, 121(22), 4053–4061. https://doi.org/10.1002/cncr.29604.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. 28.

    Engelen, V., Koopman, H. M., Detmar, S. B., Raat, H., van de Wetering, M. D., Brons, P., et al. (2011). Health-related quality of life after completion of successful treatment for childhood cancer. Pediatric Blood & Cancer, 56(4), 646–653. https://doi.org/10.1002/pbc.22795.

    Article  CAS  Google Scholar 

  29. 29.

    Barrera, M., Shaw, A. K., Speechley, K. N., Maunsell, E., & Pogany, L. (2005). Educational and social late effects of childhood cancer and related clinical, personal, and familial characteristics. Cancer, 104(8), 1751–1760. https://doi.org/10.1002/cncr.21390.

    Article  PubMed  Google Scholar 

Download references


We thank all childhood cancer survivors and families for participating in our survey. We thank the study team of the SCCSS (Rahel Kuonen, Rahel Kasteler, Jana Remlinger, Laura Wengenroth, Corina Rueegg, Cornelia Rebholz), data managers of the SPOG (Claudia Anderegg, Pamela Balestra, Nadine Beusch, Rosa-Emma Garcia, Franziska Hochreutener, Friedgard Julmy, Nadia Lanz, Rodolfo Lo Piccolo, Heike Markiewicz, Annette Reinberg, Renate Siegenthaler and Verena Stahel) and the team of the SCCR (Verena Pfeiffer, Katharina Flandera, Erika Brantschen-Berclaz, Shelagh Redmond, Meltem Altun, Parvinder Singh, Elisabeth Kiraly). We thank Kali Tal for her editorial suggestions. Swiss Paediatric Oncology Group (SPOG) Scientific Committee: Prof. Dr. med. R. Ammann, Bern; Dr. med. K. Scheinemann, Aarau; Prof. Dr. med. M. Ansari, Geneva; Prof. Dr. med. M. Beck Popovic, Lausanne; Dr. med. P. Brazzola, Bellinzona; Dr. med. J. Greiner, St. Gallen; Prof. Dr. med. M. Grotzer, Zurich; Dr. med. H. Hengartner, St. Gallen; Prof. Dr. med. T. Kuehne, Basel; Prof. Dr. med. J. Rössler, Bern; Prof. Dr. med. F. Niggli, Zurich; PD Dr. med. F. Schilling, Lucerne; Prof. Dr. med. N. von der Weid, Basel.


This study was supported by the Swiss Cancer League (Grant Nos: 3412-02-2014, 3886-02-2016), the Stiftung für Krebsbekämpfung (www.krebsbekaempfung.ch), Kinderkrebs Schweiz (www.kinderkrebs-schweiz.ch) and received funding from the European Union’s Seventh Framework Programme for research, technological development and demonstration under grant agreement no 602030. The work of the Swiss Childhood Cancer Registry is supported by the Swiss Paediatric Oncology Group (www.spog.ch), Schweizerische Konferenz der kantonalen Gesundheitsdirektorinnen und -direktoren (www.gdk-cds.ch), Swiss Cancer Research (www.krebsforschung.ch), Kinderkrebshilfe Schweiz (www.kinderkrebshilfe.ch), the Federal Office of Public Health (FOPH) and the Institute of Cancer Epidemiology and Registration (www.nicer.org). The funders of the Swiss Childhood Cancer Registry support the daily running of the registry and have not had and will not have any role in the design, conduct, interpretation, or publication of the Swiss Childhood Cancer Registry itself as well as the related research projects.

Author information




Corresponding author

Correspondence to Claudia E. Kuehni.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants accorded with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Ethics approval was granted by the Ethics Committee of the Canton of Bern to the SCCR and SCCSS (KEK-BE: 166/2014) and the SCCSS is registered at ClinicalTrials.gov (Identifier: NCT03297034).

Informed consent

Informed consent was obtained from all participants (parents and survivors) for registration in the SCCR and participation in the SCCSS survey.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (PDF 120 KB)

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Weiss, A., Sommer, G., Schindera, C. et al. Hearing loss and quality of life in survivors of paediatric CNS tumours and other cancers. Qual Life Res 28, 515–521 (2019). https://doi.org/10.1007/s11136-018-2021-2

Download citation


  • Childhood cancer
  • Ototoxicity
  • Swiss Childhood Cancer Survivor Study
  • Swiss Childhood Cancer Registry
  • Late effects
  • Cancer treatment