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.