Assessment of provider perspectives on otoprotection research for children and adolescents: A Children's Oncology Group Cancer Control and Supportive Care Committee survey

Abstract

Background: Cisplatin-induced hearing loss (CIHL) is a common and debilitating toxicity for childhood cancer survivors. Understanding provider perspectives is crucial to developing otoprotection studies that are both informative and feasible. Two international trials (ACCL0431 and SIOPEL6) investigated the drug sodium thiosulfate (STS) as an otoprotectant, but definitive interpretation of the findings of these trials has been challenging. Adoption of STS has therefore been uneven, and provider perspectives on its role are unknown. Procedure: The Children's Oncology Group (COG) Cancer Control and Supportive Care Neurotoxicity Subcommittee therefore conducted a survey of providers at COG institutions to determine perspectives on pediatric otoprotection practices and research surrounding three major themes: (1) prevalence of routine use of STS with cisplatin-based regimens, (2) application of audiometry to cisplatin therapy, and (3) preferred modalities for otoprotection research. Results: Survey respondents (45%, 44/98 surveyed institutions) were of diverse institutional sizes, practice settings, and geographical locations primarily in the United States and Canada. Overall, respondents considered CIHL an important toxicity and indicated strong enthusiasm for future studies (98%, 40/41). Results indicated that while STS was the current or planned standard of care in a minority of responding institutions (36%, 16/44), most sites were receptive to its inclusion in appropriate study designs. Application of audiometry for ototoxicity monitoring varied widely across

Use of Sodium Thiosulfate as an Otoprotectant in Patients With Cancer Treated With Platinum Compounds: A Review of the Literature

“…Acknowledging these differences, a recent reevaluation of ACCL0431 with as end point the SIOP ototoxicity criteria revealed a lower incidence of grade ≥2 CIHL in the STS arm compared with the observation arm (3/58 [5.2%] and 18/63 [28.6%], respectively). 87 This underscores the need for careful consideration of the type of hearing assessment and ototoxicity grading scale used when interpreting the prevalence of hearing loss in studies. Consequently, we suggest incorporating age-dependent audiologic testing, as recommended by Meijer et al, 88 and the SIOP ototoxicity grading scale, to facilitate uniform outcomes regarding platinum-induced hearing loss.…”

“…42 A recent survey showed that North American health care providers consider CIHL to be a concerning toxicity. 43 It is therefore important that all stakeholders are well informed on the use of STS. To date, an overview of all studies on STS is lacking.…”

Children's Oncology Group's 2023 blueprint for research: Cancer control and supportive care

“…55 A survey of CCL responsible investigators suggests that institutions are supportive of continued research into pediatric otoprotection that includes assessment of tumor response and survival. 56 In the future, the neuro-and oto-toxicty subcommittee is planning to study earlier interventions to prevent neurocognitive decline in patients with ALL.…”

Oxidative Stress and Inflammation Caused by Cisplatin Ototoxicity

“…Pediatric oncologists recommend trials of systemic rather than intratympanic route of treatment with protective agents against cisplatin [ 103 ]. A strong recommendation for continued use of systemic sodium thiosulfate in children with nonmetastatic hepatoblastoma was made.…”