Abstract
BackgroundThe 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.MethodsCase 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.ResultsThree 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).ConclusionsThere 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
Highlights
Platinum-based agents are standard curative and palliative chemotherapies used for a wide range of malignancies in both the pediatric and adult population
Evidence suggests a genetic component to the risk factors for cisplatin-induced ototoxicity, with an estimated 38–47% [16] of individual variability linked to polymorphisms in genes encoding DNA repair enzymes and membrane pumps [11,12,13, 16, 17]
We reviewed the medical records of adult patients (> 18) identified by the University of California (UC) Davis pharmacy as having received cisplatin between January 2014 and August 2017
Summary
Platinum-based agents are standard curative and palliative chemotherapies used for a wide range of malignancies in both the pediatric and adult population. Ototoxicity, the hearing disorder that results from temporary or permanent inner ear dysfunction after treatment with an ototoxic drug, is a well-documented side effect of platinum-based agents. Cisplatin is considered one of the most ototoxic pharmacologic agents, typically causing bilateral high frequency sensorineural hearing loss with progression to lower frequencies with continued exposure. The potential for permanent bilateral sensorineural hearing loss and tinnitus can occur both during treatment and up to 136 months after therapy completion [1,2,3,4,5,6,7,8] with an incidence of 20–84% [9, 10]. The outer hair cells are damaged before the inner hair cells and cisplatin damage occurs in a relatively orderly manner from base (high frequency) to apex (low frequency) destruction. 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
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