LM317 - The Evolution from Ototoxicity Monitoring to Ototoxicity Management for Cancer Treatment

Abstract:
Despite the knowledge that platinum chemotherapy and cranial radiation cause ototoxic hearing loss and tinnitus, many adults do not receive audiologic services during treatment. Children treated with cisplatin chemotherapy are more likely to have hearing monitoring during treatment, but many do not receive long-term follow-up and management of treatment-induced hearing loss. We will present recent research that has more fully characterized the impact of ototoxicity on communication, cognition and quality of life in cancer survivors. Models for delivery of ototoxicity management services will be discussed as well as resources for audiologists, patients and families.

Summary:
National ototoxicity monitoring guidelines (ASHA, 1994; AAA, 2009) recommend that individuals treated with ototoxic cancer therapies have baseline and regular monitoring for hearing loss and tinnitus. Ototoxicity monitoring is important for informing treatment decisions and initiating intervention when communicatively significant hearing loss occurs. Audiology services are not only valuable because they identify an adverse event of treatment. The real value lies in the ability to counsel on hearing loss prevention and connect individuals and families with hearing technology, rehabilitative services and resources during and beyond cancer treatment. Ototoxicity management more accurately describes the scope of audiologic services from prevention to monitoring to intervention for hearing loss, and the overarching goal of addressing communication needs while reducing long-term impacts of hearing loss.

During this learning module, we will review the prevalence of ototoxicity and risk factors in adults and children treated with platinum chemotherapy and cranial radiation. Recent research documenting the long-term effects of treatment-induced hearing loss on communication, healthcare costs, cognition, and quality of life will be presented.

Despite the high incidence of cisplatin-induced ototoxicity and the impact of hearing loss, there is a lack of uniformity in monitoring protocols and access to audiology services. Many adults do not receive audiologic services during treatment (Naples, 2022; Santucci, 2021). Children treated with cisplatin chemotherapy are more likely to have hearing monitoring during treatment, but many do not receive long-term follow-up and management of treatment-induced hearing loss (Peleva, 2014). The utilization of recommended hearing technology is also low in this population (Brinkman, 2015) and research on the outcomes of interventions is needed.

The implementation of an ototoxicity management program can be challenging due to inconsistent referrals and limitations on audiology resources, clinic space, and time (Konrad-Martin, 2018). It can also be challenging for patients and families, both from a practical perspective and emotionally. We plan to have an interactive discussion with attendees regarding ototoxicity management barriers and facilitators. Assessment protocols that are targeted for specific patient populations and treatment regimens as well as efficient evaluation or screening approaches will be shared. Creative service delivery models and options that can improve availability of audiology services will be discussed. We will share information about the work being conducted by the International Ototoxicity Management Group to address global care gaps in ototoxicity management.

Access to audiology services is improved when audiology is part of the patient’s care team (Townsend, 2017) and interdisciplinary care should be the standard for adults and children receiving ototoxic cancer therapy. Team-based care facilitates communication and clinical decision-making, and enhances the patient and families experience and satisfaction. We will discuss strategies for integrating center-based and community-based services.

Finally, we will share ototoxicity management resources for audiologists, patients and families and will query attendees to determine what additional resources and tools are needed.