Automated technology for ototoxicity monitoring (Konrad-Martin et al., 2021)
journal contributionposted on 2021-09-28, 17:42 authored by Dawn Konrad-Martin, Keri O’Connell Bennett, Angela C. Garinis, Garnett P. McMillan
Purpose: Determine the efficacy of ototoxicity monitoring (OM) administered as automated protocols with the Oto-ID mobile audiometer (automated ototoxicity monitoring [A-OM]), compared with usual care (UC) OM in cancer patients receiving cisplatin.
Method: Participants were patients (n = 46, mean age 64.7 years; range: 30–78 years) receiving cisplatin-based chemotherapy at the Department of Veterans Affairs Portland Health Care System. A randomized controlled trial contrasted A-OM and UC at up to three program evaluations (PEs) conducted by the study audiologist who was blinded to arm through PE1. PE1 occurred before randomization or oncology treatment; PE2 and PE3 occurred during and/or after treatment at 35 and 365 days postrandomization. The A-OM group (n = 24) used Oto-ID to screen their hearing before each cisplatin dose. Oto-ID results were sent to the study audiologist for interpretation, follow-up, and care coordination. The UC group (n = 22) received a consult for OM services through the audiology clinic. Outcomes included hearing shift near each patient’s high-frequency hearing limit, revised hearing-handicap inventory score, and survival time from the start of treatment. Adherence to OM protocols, patients’ use of aural rehabilitation services, and oncologists’ treatment decisions were also examined.
Results: Ototoxicity was identified at a high overall rate (46% and 76% at 35 and 365 days, respectively, postrandomization). Adherence to monitoring prior to each cisplatin dose was 83.3% for those randomized to A-OM compared with 4.5% for UC. Randomization to A-OM was not associated with reduced ototoxic hearing shifts or self-reported hearing handicap relative to UC; neither did it compromise participants’ survival. Half of participants in each arm accessed aural rehabilitation services. One in each arm had a documented ototoxicity-related cisplatin dose reduction.
Conclusions: Auditory impairment was an actionable concern for the participants and their oncology providers. A dedicated surveillance program using the Oto-ID’s automated protocols improved adherence to OM recommendations over a traditional UC service delivery model.
Supplemental Material S1. Patient demographics, clinical aspects of diagnosed cancer and hearing characteristics by treatment arm and primary tumor location.
Supplemental Material S2. Audiograms comparing those with and without an ototoxic hearing shift.
Supplemental Material S3. The numbers and types of chemotherapy treatment modifications by study arm and participant.
Konrad-Martin, D., Bennett, K. O., Garinis, A.. & McMillan, G. P. (2021). A randomized controlled trial using automated technology for improving ototoxicity monitoring in VA oncology patients. American Journal of Audiology. Advance online publication. https://doi.org/10.1044/2021_AJA-21-00032
Publisher Note: This article is part of the Special Issue: Selected Papers From the 9th Biennial National Center for Rehabilitative Auditory Research Conference.
This work was supported in part by a VA Rehabilitative Research & Development (RR&D) Services Merit Review Award (Grant C0239R) and with resources and the use of facilities at the NCRAR (RR&D Center Award #C2361-C).
ototoxicityoncologyVADepartment of Veterans Affairsrandomized controlled trialtechnologyautomatedmonitoringefficacyaudiometercisplatinchemotherapyprogram evaluationaudiologistaudiologyhearingclinichigh frequencyhearing handicap inventoryauralrehabilitationoncologisttreatmentototoxicsurvivaldoseconcernsurveillanceprotocolservice delivery modelHealth CareHealth Care Administration