BACKGROUND: Platinum-based chemotherapy is very effective in treating a variety of cancer types however, it has the potential to cause dose limiting ototoxicity that may result in permanent hearing loss. Studies have shown that hearing loss can affect quality of life by interfering with relationships and degrading communication. Early detection of hearing loss assists the oncologist in determining drug dosing and selecting the appropriate treatment regimens. It also allows the audiologist the opportunity for early intervention with rehabilitative measures. At our facility, Veterans starting cisplatin did not consistently have an audiology consult placed or a baseline audiogram completed prior to initiating treatment. A literature review was conducted, and an interdisciplinary team was formed with key stakeholders from medical oncology, audiology, pharmacy, and nursing.
RESULTS: The initial data review from January 1, 2016 to August 8, 2018 (n=85) showed only 17 Veterans (20%) had an audiology consult placed prior to initiating treatment. The target timeframe determined by the audiology department for baseline audiogram completion was eight weeks prior to or up to 24 hours post initial cisplatin administration. Following these guidelines, only seven (8%) of the 17 audiology consults were placed and completed within the recommended timeframe. Our goal was to increase the number of Veterans receiving audiograms prior to cisplatin administration from 8% to 100% by January 1, 2020.
INTERVENTIONS: enhanced provider education for early identification of Veterans starting cisplatin, creation of an email group for increased communication between nursing and audiology, trialing a portable audiometer in the outpatient infusion clinic, and adding a quick order set to the audiology consult on all cisplatin templates. A post-intervention data review from January 1, 2020 to April 30, 2020 (n=17) demonstrated all 17 (100%) Veterans had an audiology consult placed prior to the first dose of cisplatin. The data review also showed that 17 out of 17 Veterans (100%) had an audiogram completed within the target timeframe. This quality improvement project is aimed at maintaining quality of life for our Veterans throughout their cancer journey.