ABSTRACT

Objectives: Evaluate patterns of ototoxicity monitoring among cancer patients treated with cisplatin.

Methods: We performed a retrospective cohort study on adults with cancer treated with cisplatin from an ototoxicity monitoring program at a tertiary care center. The primary outcomes were rates of post-treatment audiograms at the guideline-recommended time points of one month, three months, six months, 12 months, and annually thereafter. Multivariable logistic regression was performed to identify risk factors associated with complete loss to follow-up after pre-treatment evaluation.

Expected Findings: Poor adherence to ototoxic monitoring program and barriers like rural community setting, lack of insurance, and high ADI. 

 


 

Summary:

Cisplatin is a chemotherapy agent used in 10 to 20% of all cancers in the United States^1,2. It causes irreversible dose-dependent hearing loss in 40-80% of adults and 50% of pediatric patients^3-6. This loss of hearing leads to social isolation and depression in adults and delays in speech and language acquisition in children^7-9. Head and neck cancer patients are particularly vulnerable to treatment-related ototoxicity because concurrent radiation, which is commonly used in managing these cancers, places the nearby cochlea at risk for radiotoxicity^10-12. As advances in cisplatin-based chemoradiation (CRT) therapy improve survival outcomes, developing strategies to mitigate, reverse, and rehabilitate hearing loss may substantially impact survivorship in this patient population.

Current surveillance guidelines issued by the American Speech and Language Hearing Association (ASHA) and the American Academy of Audiology (AAA) recommend pre-treatment baseline monitoring, interval monitoring during treatment, and post-treatment monitoring for up to 12 months, and annually thereafter as needed. This ototoxicity surveillance schedule is effective for early detection of cisplatin-induced hearing loss^13,14. However, ototoxicity monitoring requires complex coordination between patients, medical oncologists, radiation oncologists, audiologists, and otolaryngologists, raising feasibility concerns about adhering to aggressive monitoring. In addition, logistical challenges of coordinating audiologic follow-up with oncologic surveillance add a further layer of complexity to this problem^15,16. A recent study investigating compliance with ototoxicity monitoring guidelines demonstrated that less than 25% of patients treated with cisplatin had a pre-treatment audiogram¹⁷. However, patterns of audiologic follow-up among those already enrolled in an ototoxicity monitoring program remain unknown.

This study aimed to investigate trends in audiologic follow-up among cisplatin-treated cancer patients enrolled in an ototoxicity monitoring program at a tertiary care center and identify factors associated with complete loss of follow-up. Findings from this study may inform interventions targeted at reducing untreated cisplatin-induced hearing loss among cancer survivors and contribute towards a more nuanced understanding of ototoxicity monitoring practices. We hypothesized that rural community setting, lack of insurance, and high ADI would decrease adherence to cisplatin ototoxicity monitoring.
We performed a single-center retrospective cohort study on cancer patients enrolled in an ototoxicity monitoring program before CRT to investigate patterns in post-treatment audiologic follow-up and factors associated with complete loss of follow-up. The Institutional Review Board of Washington University approved this study.