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Cisplatin Ototoxicity: Evidence for Dosing Effect on the Risk of Hearing Shifts Among Head and Neck Cancer Patients Receiving Chemoradiation
Background: Between 2008 and 2014, 17,173 Veterans were treated with cisplatin-based chemotherapy. Many began treatment with pre-existing hearing loss and up to half likely sustained ototoxicity. Minor shifts in hearing, left untreated, can constrain effective provider-veteran
treatment partnerships, family and workplace communication, and limit quality of life. A better understanding of the risk factors and clinical presentation of ototoxicity is needed to inform ototoxicity monitoring programs and treatment decisions.
Methods: Data were examined in N = 21 head and neck cancer patients receiving concurrent chemoradiation therapy with cisplatin for whom audiometry data had been obtained prior to treatment and at 1 or more time points (35 days and 165 days) following the initial treatment.
Data were gathered as part of a larger prospective study on ototoxicity monitoring at the VA Portland HCS from 2014 to 2017. The primary outcome was a shift in the audiogram based on the National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE) Grades 1 or greater, which was evaluated in relation to cisplatin dosing (> 75 mg/m2 every 3 weeks (bolus) vs weekly dosing < 40 mg/m2). Effects of dosing on the risk of CTCAE grade 1 or greater ototoxic event were estimated using Bayesian analysis. Descriptive statistics characterize additional
factors (age, pre-existing hearing loss and ototoxic hearing shifts, cisplatin cumulative dose, radiation dose).
Results: Ototoxicity meeting CTCAE grade 1 was found at a rate of 23.8%. The estimated risk of ototoxicity did not vary by hearing monitoring method. Veterans receiving bolus-dose cisplatin chemoradiation are estimated to be at double the risk of ototoxicity than those receiving lower weekly dosing.
Implications: Evidence supports the view that CTCAE grade 1 or higher ototoxicity was associated with cisplatin dosing in this sample. High-dose regimens are more likely to cause ototoxicity and this increased risk does not appear to vary based on method of delivery of ototoxicity monitoring. Effects of cisplatin cumulative dose and radiation dose, as well as implications for ototoxicity monitoring, will be discussed.
Background: Between 2008 and 2014, 17,173 Veterans were treated with cisplatin-based chemotherapy. Many began treatment with pre-existing hearing loss and up to half likely sustained ototoxicity. Minor shifts in hearing, left untreated, can constrain effective provider-veteran
treatment partnerships, family and workplace communication, and limit quality of life. A better understanding of the risk factors and clinical presentation of ototoxicity is needed to inform ototoxicity monitoring programs and treatment decisions.
Methods: Data were examined in N = 21 head and neck cancer patients receiving concurrent chemoradiation therapy with cisplatin for whom audiometry data had been obtained prior to treatment and at 1 or more time points (35 days and 165 days) following the initial treatment.
Data were gathered as part of a larger prospective study on ototoxicity monitoring at the VA Portland HCS from 2014 to 2017. The primary outcome was a shift in the audiogram based on the National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE) Grades 1 or greater, which was evaluated in relation to cisplatin dosing (> 75 mg/m2 every 3 weeks (bolus) vs weekly dosing < 40 mg/m2). Effects of dosing on the risk of CTCAE grade 1 or greater ototoxic event were estimated using Bayesian analysis. Descriptive statistics characterize additional
factors (age, pre-existing hearing loss and ototoxic hearing shifts, cisplatin cumulative dose, radiation dose).
Results: Ototoxicity meeting CTCAE grade 1 was found at a rate of 23.8%. The estimated risk of ototoxicity did not vary by hearing monitoring method. Veterans receiving bolus-dose cisplatin chemoradiation are estimated to be at double the risk of ototoxicity than those receiving lower weekly dosing.
Implications: Evidence supports the view that CTCAE grade 1 or higher ototoxicity was associated with cisplatin dosing in this sample. High-dose regimens are more likely to cause ototoxicity and this increased risk does not appear to vary based on method of delivery of ototoxicity monitoring. Effects of cisplatin cumulative dose and radiation dose, as well as implications for ototoxicity monitoring, will be discussed.
Background: Between 2008 and 2014, 17,173 Veterans were treated with cisplatin-based chemotherapy. Many began treatment with pre-existing hearing loss and up to half likely sustained ototoxicity. Minor shifts in hearing, left untreated, can constrain effective provider-veteran
treatment partnerships, family and workplace communication, and limit quality of life. A better understanding of the risk factors and clinical presentation of ototoxicity is needed to inform ototoxicity monitoring programs and treatment decisions.
Methods: Data were examined in N = 21 head and neck cancer patients receiving concurrent chemoradiation therapy with cisplatin for whom audiometry data had been obtained prior to treatment and at 1 or more time points (35 days and 165 days) following the initial treatment.
Data were gathered as part of a larger prospective study on ototoxicity monitoring at the VA Portland HCS from 2014 to 2017. The primary outcome was a shift in the audiogram based on the National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE) Grades 1 or greater, which was evaluated in relation to cisplatin dosing (> 75 mg/m2 every 3 weeks (bolus) vs weekly dosing < 40 mg/m2). Effects of dosing on the risk of CTCAE grade 1 or greater ototoxic event were estimated using Bayesian analysis. Descriptive statistics characterize additional
factors (age, pre-existing hearing loss and ototoxic hearing shifts, cisplatin cumulative dose, radiation dose).
Results: Ototoxicity meeting CTCAE grade 1 was found at a rate of 23.8%. The estimated risk of ototoxicity did not vary by hearing monitoring method. Veterans receiving bolus-dose cisplatin chemoradiation are estimated to be at double the risk of ototoxicity than those receiving lower weekly dosing.
Implications: Evidence supports the view that CTCAE grade 1 or higher ototoxicity was associated with cisplatin dosing in this sample. High-dose regimens are more likely to cause ototoxicity and this increased risk does not appear to vary based on method of delivery of ototoxicity monitoring. Effects of cisplatin cumulative dose and radiation dose, as well as implications for ototoxicity monitoring, will be discussed.
Ototoxicity From Cisplatin: Who Is at Risk and Who May Benefit From Treatment?
Purpose: This study sought to characterize the incidence of cisplatin-induced hearing change by cancer location and aspects of the treatment regimen in a sample of Veterans undergoing chemotherapy at the VA Portland HCS. An additional goal was to characterize the severity of hearing loss prior to treatment and the contributions of cisplatin-induced hearing loss in relation to the need for auditory rehabilitation.
Background: Between 2008 and 2014, 17,173 Veterans were treated with cisplatin chemotherapy. Many began treatment with pre-existing hearing loss and up to half likely sustained ototoxicity. Even minor shifts in hearing, left untreated, can constrain effective provider-Veteran treatment partnerships, family and workplace communication, and can significantly limit optimal quality of life following cancer.
Methods: Serial hearing testing and medical records data were obtained prospectively from 2011-2016 in N = 87 cancer patients. Baseline hearing tests were completed within 24 hours of the first cisplatin treatment, during and after treatment. The primary outcome was a shift in the audiogram based on the NCI Common Terminology Criteria for Adverse Events (CTCAE) Grades 1-4 and American Speech-Language-Hearing Association (ASHA) guidelines for a significant ototoxic shift. Hearing shifts that met criteria for CTCAE Grade 1 were further evaluated in relation to cisplatin cumulative dose, initial dose, concurrent radiation and cancer location.
Data Analysis: Descriptive statistics characterize the severity of pre-existing hearing loss and ototoxic changes. Effects of cisplatin dose, cancer location, and radiation on the risks for CTCAE Grade 1 ototoxic event were estimated using hierarchical logistic regression.
Results: Ototoxicity meeting CTCAE grade 3 were found at a rate of 19% for head and neck cancers. This group warrants priority surveillance. Less severe (Grade 1) shifts were found at high rates across other cancer locations assessed in this study. CTCAE Grade 1 ototoxicity is associated with cancer location, starting dose, and concurrent radiation. Importantly, Grade 1 exceeds the magnitude of an ASHA-significant hearing shift by definition. These Veterans are a high priority group for hearing monitoring and rehabilitation service provision by Audiology.
Implications: CTCAE Grade 1 ototoxicity is a commonly occurring toxicity that may limit Veteran-provider communication and quality of life.
Purpose: This study sought to characterize the incidence of cisplatin-induced hearing change by cancer location and aspects of the treatment regimen in a sample of Veterans undergoing chemotherapy at the VA Portland HCS. An additional goal was to characterize the severity of hearing loss prior to treatment and the contributions of cisplatin-induced hearing loss in relation to the need for auditory rehabilitation.
Background: Between 2008 and 2014, 17,173 Veterans were treated with cisplatin chemotherapy. Many began treatment with pre-existing hearing loss and up to half likely sustained ototoxicity. Even minor shifts in hearing, left untreated, can constrain effective provider-Veteran treatment partnerships, family and workplace communication, and can significantly limit optimal quality of life following cancer.
Methods: Serial hearing testing and medical records data were obtained prospectively from 2011-2016 in N = 87 cancer patients. Baseline hearing tests were completed within 24 hours of the first cisplatin treatment, during and after treatment. The primary outcome was a shift in the audiogram based on the NCI Common Terminology Criteria for Adverse Events (CTCAE) Grades 1-4 and American Speech-Language-Hearing Association (ASHA) guidelines for a significant ototoxic shift. Hearing shifts that met criteria for CTCAE Grade 1 were further evaluated in relation to cisplatin cumulative dose, initial dose, concurrent radiation and cancer location.
Data Analysis: Descriptive statistics characterize the severity of pre-existing hearing loss and ototoxic changes. Effects of cisplatin dose, cancer location, and radiation on the risks for CTCAE Grade 1 ototoxic event were estimated using hierarchical logistic regression.
Results: Ototoxicity meeting CTCAE grade 3 were found at a rate of 19% for head and neck cancers. This group warrants priority surveillance. Less severe (Grade 1) shifts were found at high rates across other cancer locations assessed in this study. CTCAE Grade 1 ototoxicity is associated with cancer location, starting dose, and concurrent radiation. Importantly, Grade 1 exceeds the magnitude of an ASHA-significant hearing shift by definition. These Veterans are a high priority group for hearing monitoring and rehabilitation service provision by Audiology.
Implications: CTCAE Grade 1 ototoxicity is a commonly occurring toxicity that may limit Veteran-provider communication and quality of life.
Purpose: This study sought to characterize the incidence of cisplatin-induced hearing change by cancer location and aspects of the treatment regimen in a sample of Veterans undergoing chemotherapy at the VA Portland HCS. An additional goal was to characterize the severity of hearing loss prior to treatment and the contributions of cisplatin-induced hearing loss in relation to the need for auditory rehabilitation.
Background: Between 2008 and 2014, 17,173 Veterans were treated with cisplatin chemotherapy. Many began treatment with pre-existing hearing loss and up to half likely sustained ototoxicity. Even minor shifts in hearing, left untreated, can constrain effective provider-Veteran treatment partnerships, family and workplace communication, and can significantly limit optimal quality of life following cancer.
Methods: Serial hearing testing and medical records data were obtained prospectively from 2011-2016 in N = 87 cancer patients. Baseline hearing tests were completed within 24 hours of the first cisplatin treatment, during and after treatment. The primary outcome was a shift in the audiogram based on the NCI Common Terminology Criteria for Adverse Events (CTCAE) Grades 1-4 and American Speech-Language-Hearing Association (ASHA) guidelines for a significant ototoxic shift. Hearing shifts that met criteria for CTCAE Grade 1 were further evaluated in relation to cisplatin cumulative dose, initial dose, concurrent radiation and cancer location.
Data Analysis: Descriptive statistics characterize the severity of pre-existing hearing loss and ototoxic changes. Effects of cisplatin dose, cancer location, and radiation on the risks for CTCAE Grade 1 ototoxic event were estimated using hierarchical logistic regression.
Results: Ototoxicity meeting CTCAE grade 3 were found at a rate of 19% for head and neck cancers. This group warrants priority surveillance. Less severe (Grade 1) shifts were found at high rates across other cancer locations assessed in this study. CTCAE Grade 1 ototoxicity is associated with cancer location, starting dose, and concurrent radiation. Importantly, Grade 1 exceeds the magnitude of an ASHA-significant hearing shift by definition. These Veterans are a high priority group for hearing monitoring and rehabilitation service provision by Audiology.
Implications: CTCAE Grade 1 ototoxicity is a commonly occurring toxicity that may limit Veteran-provider communication and quality of life.