Insight into the current practice of ototoxicity monitoring during cisplatin therapy

Abstract

Background The aim of this study is to evaluate the current state of ototoxicity monitoring for patients receiving cisplatin chemotherapy in an academic medical center with particular attention to how closely monitoring adheres to national ototoxicity guidelines. Methods Case series including retrospective medical records review of patients (age > 18) treated with cisplatin at University of California Davis Medical Center between January 2014 and August 2017. Patient and ototoxicity related variables were analyzed. Patients that underwent a transfer of care during treatment and with less than 3 months of follow-up were excluded. Results Three hundred seventy-nine patients met study criteria, of which 104 (27.4%) had a prior history of hearing loss. Prior to treatment, 196 (51.7%) patients were counseled regarding the ototoxic nature of cisplatin and 92 (24.3%) patients had a pretreatment audiogram. During treatment, 91 (24%) patients had documented otologic complaints. Only 17 patients (4.5%) patients had an audiogram ordered during their cisplatin treatment period. 130 (34.3%) patients had otologic complaints following cisplatin treatment. Audiograms were ordered for 20 (7.8%), 13 (5.1%), and 16 (6.2%) patients at 1-month, 3-month, and 6-month follow-ups, respectively. No patients in the study cohort received baseline, treatment, and post-treatment audiograms as recommended by national ototoxicity monitoring protocols. Patients with Head and Neck Cancer (HNC) represented the largest subgroup that received cisplatin (n = 122, 32.2%) and demonstrated higher rates of ototoxicity counseling (n = 103, 84.4%) and pretreatment audiograms (n = 70, 57.4%) compared to the non HNC group (n = 36, 36.2%, P < 0.0001 and n = 22, 8.5%, P < 0.0001). Conclusions There is poor adherence to national ototoxicity monitoring guidelines at a large academic medical center. This is a missed opportunity for intervention and aural rehabilitation. Improved education and collaboration between otolaryngology, audiology, and medical oncology is needed to develop and promote an effective ototoxicity-monitoring program. Graphical abstract

Audiologists’ perceived value of ototoxicity management and barriers to implementation for at-risk cancer patients in VA: the OtoMIC survey

“…A similar lack of effective OtoM delivery was also observed in a recent chart review of 379 patients who received cisplatin at UC Davis Medical Center. Although 24% of patients had hearing complaints documented in their medical record, only 4.5% received an audiometric evaluation during cisplatin treatment [ 35 ].…”

Rapidly progressive hearing loss occurring over weeks: review of differential diagnoses

“…Twenty-three studies were reviewed to identify the underlying pathologies responsible for rapidly progressive hearing loss (Figure 3). 3,5–26 The key findings of the literature review are summarised below, and within Tables 2 and 3.

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“…All reported cases of rapidly progressive hearing loss were sensorineural in nature (Table 2). 3,5–26…”

“…This is believed to be dose-dependent and cumulative in nature. 25,26,37 Symptoms can develop days to weeks after the commencement of drug therapy. Cisplatin and aminoglycoside antibiotics are the two most widely implicated ototoxic medications.…”

“…suggest that patients undergoing platinum-based chemotherapy should have their hearing monitored pre-, peri- and post-treatment. 26…”