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Case history

image A 78-year-old woman presented following a sudden collapse with one witnessed seizure, on a background of increasing headaches over 1 week. Her past medical history consisted of type 2 diabetes and osteoarthritis. Her Mini-Mental State Examination score on admission was 26 out of 30. Initial investigations revealed an invasive ring-enhancing lesion in the left temporal lobe, consistent with a glioblastoma, with surrounding oedema and mild effacement of the left lateral ventricle. Following discussion with the oncologist, she was started on high-dose steroids and referred to the neuro-oncology multidisciplinary team (MDT), who recommended primary debulking surgery followed by radiotherapy. She was commenced on levetiracetam to prevent further seizures.

Two weeks following partial resection of the left temporal lobe, she attended clinic to discuss radiotherapy. During the consultation the oncologist noticed that she struggled to take in much of the information and therefore used a Comprehensive Geriatric Assessment screening tool, which revealed a significant hearing impairment. Concerned about the communication challenges, the oncologist arranged to see her again in 2 weeks with an urgent referral to the ENT clinic in the interim. Here, a thorough assessment identified several issues relating to her hearing:

  • Conductive hearing loss secondary to excess earwax. After a week's treatment with olive oil ear drops, she visited the practice nurse to have her ears syringed, with immediate improvement in hearing.

  • Age-related sensorineural deficit (presbycusis) in both ears, requiring a referral to the audiology department for bilateral fitted hearing aids.

  • She had become increasingly withdrawn from her social network of family and friends due to difficulty in keeping up with conversation. She was also afraid of leaving her home and going to the shops on her own, as she could not hear the traffic very well.

On return to the oncology clinic, she was much brighter in mood and remained keen to engage in further treatment options. She had completed a course of tapering steroids. However, since then her blood sugar control had remained poor and so she was commenced on insulin by the community diabetes team. The oncologist explained the side effects of radiotherapy and recommended a course of 40 Gy in 15 fractions to the affected brain. She completed the treatment, the only toxicities being grade 2 fatigue, grade 1 scalp rash, and alopecia.

What was the goal of cancer treatment for this patient?

What impact can hearing loss have on the older cancer patient?

What toxicities are associated with her treatment?

What is the evidence base for her treatment?

How did comorbidities affect her cancer care?

How can hearing loss be identified and managed in cancer services?

What was the goal of cancer treatment for this patient?

Glioblastoma, or grade 4 astrocytoma, is the most common form of malignant primary brain tumour and has an annual incidence in the UK of around three new cases per 100,000 people. The peak age of incidence is 65-74 years; however, the number of ...

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