Cisplatin, Hearing Loss, and the Case for Hearing-Inclusive, Holistic Care
Introduction: a survivorship issue we are still learning to see
Cisplatin has long been a cornerstone of modern cancer treatment. Its effectiveness across a wide range of tumour sites has transformed outcomes and saved countless lives. For many patients, cisplatin represents hope, possibility and a future that might otherwise have been lost.
Alongside these successes, however, sits a quieter reality - one that is less visible within clinical pathways, yet deeply felt by many who receive treatment. Cisplatin is known to be ototoxic, and for a significant number of adults this results in permanent hearing loss. While this is well documented in the literature, its lived impact is still often under-recognised within survivorship care.
Each year in the UK, an estimated 11,000–14,000 adults experience hearing loss linked to cisplatin chemotherapy. Despite this, hearing change is not consistently monitored in adult oncology services, nor is it always discussed in ways that prepare individuals for the functional and emotional consequences that may follow.
This article invites a broader, gentler view of survivorship. It explores cisplatin-related hearing loss not as a secondary side effect, but as a meaningful part of many patients’ post-treatment lives. It considers how hearing change can affect communication, safety, confidence and recovery, and reflects on how personalised, holistic health coaching may offer valuable complementary support alongside medical care.
The aim is not to add burden to already stretched systems, but to widen understanding - recognising that excellent cancer care extends beyond disease control, into how people live, communicate and reconnect with life after treatment.
Cisplatin-related hearing loss: what the evidence tells us
The association between cisplatin and permanent sensorineural hearing loss is well established. Research in adult populations consistently reports high incidence rates, with risk increasing alongside cumulative dose, treatment intensity, concurrent radiotherapy, renal impairment and individual susceptibility.
Typically, cisplatin-related hearing loss begins in the high frequencies. This makes it easy to overlook in its early stages, both clinically and subjectively. Patients may not initially describe their experience as “hearing loss.” Instead, they may notice increased difficulty following conversation in noisy environments, greater effort required to listen, tinnitus, or a sense that speech feels unclear or distorted rather than quieter.
Over time, these subtle changes can progress into more significant and permanent hearing impairment. For some individuals, the impact becomes apparent only after treatment has ended - at a point when oncology contact may be reducing and expectations are shifting towards recovery and normality.
Despite this, adult audiological monitoring remains inconsistent. Baseline hearing assessments are not universally offered, and follow-up testing may be absent or delayed. Many individuals complete treatment without a clear understanding of what hearing changes to look out for, or where to seek help should difficulties arise.
For clinicians, whose focus is understandably on tumour response, toxicity management and survival, hearing loss can appear peripheral. For patients, however, it often becomes woven into the fabric of daily life - affecting how they work, relate to others and engage with healthcare itself.
Hearing loss and communication: an often-invisible barrier
Hearing underpins almost every healthcare interaction. When hearing loss is unrecognised, communication can be compromised in ways that are subtle yet significant.
Patients may struggle to fully understand complex or emotionally charged information, particularly when consultations are time-limited, language is technical, or multiple issues are discussed at once. Face coverings, background noise, unfamiliar accents, or rapid speech can further increase listening effort.
Medication instructions, safety advice, and follow-up plans may be partially missed or misunderstood - not through lack of engagement, but through reduced access. Patients may hesitate to ask for repetition, particularly if they are unsure whether their difficulty is “serious enough” to mention.
In these situations, individuals can appear distracted, anxious, or disengaged, when in reality they are working hard simply to keep up. Over time, this can erode confidence and trust, making healthcare encounters increasingly stressful.
There are also implications for informed consent and shared decision-making. When communication is compromised, patients may consent without fully understanding, or leave appointments feeling uncertain and unsupported. This is not a failure of care, but a reminder of how easily access barriers can arise when hearing loss goes unrecognised.
Because hearing loss is often invisible, these challenges may remain unnamed. Both clinician and patient may sense that consultations feel harder than they should, without a shared understanding of why.
Life beyond treatment: the wider impact of hearing loss
Survivorship is a period of transition. For many, it involves gradually rebuilding confidence, identity and routine after the intensity of cancer treatment. Hearing loss can complicate this process in ways that are not always anticipated.
Listening fatigue is a common experience. Conversations that once felt effortless may now require sustained concentration, leading to exhaustion, headaches or irritability. This is particularly challenging when combined with post-treatment fatigue or cognitive changes.
Social situations can become harder to navigate. Background noise, group conversations and informal interactions may feel overwhelming, prompting some individuals to withdraw from activities they once enjoyed. This withdrawal is often misunderstood as low mood or lack of motivation, rather than a practical response to increased effort and strain.
Workplace confidence may also be affected. Misunderstandings, missed information, or fear of appearing “less capable” can undermine self-esteem at a time when individuals are striving to regain normality and independence.
Emotionally, treatment-related hearing loss can carry a particular weight. It may arrive unexpectedly, at a moment when patients are hoping to move on from cancer. For some, it represents a lasting reminder of illness - a change that feels unjust, permanent and difficult to reconcile.
These experiences sit squarely within survivorship, yet they may fall outside the scope of traditional follow-up care.
The space between treatment and living
Oncology follow-up is rightly focused on surveillance, recurrence and the management of physical late effects. Within these constraints, there is often limited opportunity to explore how individuals are adapting to the broader consequences of treatment.
Audiology services play a vital role in assessment and rehabilitation, yet access may be delayed, and practical support can vary. Even when hearing aids are provided, people may be left to navigate the emotional, social, and communicative implications largely on their own.
Hearing loss does not exist in isolation. It interacts with fatigue, stress, sleep disruption, confidence and identity. Patients may know what has changed but feel uncertain about how to live well with it.
This is the space where complementary approaches can offer meaningful support.
Where personalised, holistic health coaching can help
Health coaching does not replace medical treatment, nor does it attempt to “fix” hearing loss. Instead, it offers a supportive, structured space in which individuals can explore change, regain agency and move forward in ways that feel realistic and compassionate.
For people adjusting to hearing loss after cancer treatment, health coaching can provide time - time to reflect, to process loss, and to make sense of what life now looks like. It offers an opportunity to focus not only on symptoms, but on the person as a whole.
A holistic coaching approach may support individuals to:
Understand and manage listening fatigue, stress and energy levels
Develop practical communication strategies for healthcare, work and social life
Build confidence and self-advocacy skills
Re-establish supportive routines around nutrition, movement, rest and wellbeing
Set goals that reflect personal values and changing priorities
Coaching is collaborative rather than directive. It recognises that each person’s experience of hearing loss and survivorship is shaped by their context, relationships and sense of identity. By working at the pace of the individual, coaching can help bridge the gap between clinical care and everyday living.
Why this matters for healthcare professionals
From a professional and systems perspective, health coaching aligns closely with patient-centred and value-based models of care. By supporting individuals to understand and adapt to treatment consequences, it can enhance engagement, self-management and long-term wellbeing.
Patients who feel heard and supported are often better able to articulate concerns, participate in decision-making and follow care plans. This can improve the quality of clinical interactions and reduce frustration on both sides.
Importantly, hearing-inclusive approaches promote equity. Communication access is fundamental to safe, ethical and effective healthcare. Recognising and responding to hearing loss is not an optional extra - it is part of providing dignified, inclusive care.
Health coaching will not be appropriate for everyone, and it is not a substitute for audiological or medical input. However, as part of a broader survivorship framework, it offers a flexible, person-centred option that complements existing services.
Small adjustments, lasting difference
Hearing-inclusive care does not require specialist knowledge or significant additional resource. Often, it begins with awareness and curiosity.
Simple steps can have a meaningful impact:
Acknowledging ototoxic risk and discussing hearing changes openly
Asking gentle screening questions during follow-up
Ensuring clear, face-to-face communication where possible
Checking understanding without placing pressure on the patient
Signposting early to audiology, rehabilitation and supportive services
Recognising when additional support, such as health coaching, may be beneficial
These practices benefit many patients, not only those with hearing loss. Inclusive communication improves care quality for all.
Conclusion: caring for life after treatment
Cisplatin has transformed cancer care and saved lives. Its success deserves to be matched by survivorship pathways that recognise the full range of its long-term effects.
Hearing loss following cancer treatment is common, impactful and too often overlooked. When unrecognised, it can affect communication, confidence, safety and quality of life - at a time when individuals are already navigating profound change.
By acknowledging hearing loss as a meaningful survivorship issue, and by embracing hearing-inclusive, holistic approaches such as personalised health coaching, healthcare professionals can support patients more fully as they move beyond treatment.
Survivorship care is at its strongest when it combines clinical excellence with compassion, inclusion and attention to lived experience. In doing so, we help people not only survive cancer, but find steadiness, confidence and connection in the life that follows.
References
The information and perspectives in this article are informed by the following key sources:
Knight KR, Kraemer DF, Neuwelt EA. Ototoxicity in children receiving platinum chemotherapy: underestimating a commonly occurring toxicity that may influence academic and social development. J Clin Oncol. 2005;23(34):8588–8596.
(Foundational research on platinum-related ototoxicity, with relevance across age groups.)
Landier W. Ototoxicity and cancer therapy. Cancer. 2016;122(11):1647–1658.
(Comprehensive review of mechanisms, prevalence, and clinical implications of treatment-related hearing loss.)
Grewal S, Merchant T, Reymond R, et al. Auditory late effects of childhood cancer therapy: a report from the Children’s Oncology Group. Pediatrics. 2010;125(4):e938–e950.
(While paediatric-focused, provides valuable insight into long-term functional impact.)
International Society of Audiology. Guidelines for the early detection and management of ototoxicity.
(Clinical guidance relevant to adult oncology pathways.)
National Institute for Health and Care Excellence (NICE). Improving supportive and palliative care for adults with cancer.
(Framework supporting holistic, person-centred survivorship care.)
World Health Organization. World Report on Hearing. 2021.
(Authoritative overview of hearing loss as a public health and quality-of-life issue.)
Wolever RQ, Simmons LA, Sforzo GA, et al. A systematic review of the literature on health and wellness coaching.Global Advances in Health and Medicine. 2013;2(4):38–57.
(Evidence base for health coaching as a complementary, patient-centred intervention.)