What topics should be addressed in a presentation about ototoxicity in oncology?

From the Guidelines

For a presentation on ototoxicity in oncology, I recommend covering these key topics: definition of ototoxicity and its prevalence in cancer patients; major ototoxic chemotherapeutic agents, particularly platinum compounds like cisplatin (40-80% risk) and carboplatin; pathophysiological mechanisms of cochlear damage, including oxidative stress and DNA damage to hair cells; risk factors such as cumulative dose, age extremes, pre-existing hearing loss, and concurrent cranial radiation; clinical manifestations including high-frequency hearing loss, tinnitus, and vestibular dysfunction; monitoring protocols with baseline and serial audiometric testing; prevention strategies such as dose modification, protective agents (sodium thiosulfate, N-acetylcysteine), and drug delivery modifications; management approaches for established ototoxicity; quality of life impact, especially in pediatric patients where language development may be affected; and future research directions in protective agents and targeted therapies. This comprehensive approach will provide healthcare professionals with practical knowledge to identify, prevent, and manage this significant side effect of cancer treatment that can have lasting impacts on patients' communication abilities and overall quality of life, as supported by recent guidelines and studies 1.

Key Topics to Cover

• Definition and prevalence of ototoxicity in cancer patients
• Major ototoxic chemotherapeutic agents, such as cisplatin and carboplatin
• Pathophysiological mechanisms of cochlear damage
• Risk factors, including cumulative dose, age extremes, pre-existing hearing loss, and concurrent cranial radiation
• Clinical manifestations, including high-frequency hearing loss, tinnitus, and vestibular dysfunction
• Monitoring protocols, such as baseline and serial audiometric testing
• Prevention strategies, including dose modification, protective agents, and drug delivery modifications
• Management approaches for established ototoxicity
• Quality of life impact, especially in pediatric patients
• Future research directions in protective agents and targeted therapies

Recent Guidelines and Recommendations

The most recent guidelines and studies, such as those published in The Lancet Oncology 1 and The Lancet Child and Adolescent Health 1, provide evidence-based recommendations for the prevention and management of ototoxicity in cancer patients. These guidelines emphasize the importance of monitoring and prevention strategies, such as the use of sodium thiosulfate, and highlight the need for further research in this area.

Clinical Implications

The topics covered in the presentation will have significant clinical implications for healthcare professionals, including oncologists, audiologists, and primary care physicians. By understanding the risks and mechanisms of ototoxicity, healthcare professionals can take steps to prevent and manage this significant side effect of cancer treatment, ultimately improving the quality of life for cancer patients and survivors. As noted in recent studies 1, the implementation of surveillance and prevention strategies can reduce the risk of ototoxicity and improve outcomes for cancer patients.

From the FDA Drug Label

Ototoxicity has been observed in up to 31% of patients treated with a single dose of cisplatin 50 mg/m 2, and is manifested by tinnitus and/or hearing loss in the high frequency range (4,000 to 8,000 Hz). The prevalence of hearing loss in children is particularly high and is estimated to be 40 to 60%. Decreased ability to hear normal conversational tones may occur Deafness after the initial dose of cisplatin has been reported. Ototoxic effects may be more severe in children receiving cisplatin. Hearing loss can be unilateral or bilateral and tends to become more frequent and severe with repeated cisplatin doses. It is unclear whether cisplatin-induced ototoxicity is reversible. Vestibular toxicity has also been reported Ototoxic effects may be related to the peak plasma concentration of cisplatin. Ototoxicity can occur during treatment or be delayed. Audiometric monitoring should be performed prior to initiation of therapy, prior to each subsequent dose, and for several years post therapy The risk of ototoxicity may be increased by prior or simultaneous cranial irradiation, and may be more severe in patients less than 5 years of age, patients being treated with other ototoxic drugs (e.g., aminoglycosides and vancomycin), and in patients with renal impairment. Genetic factors (e.g., variants in the thiopurine S-methyltransferase [TPMT] gene) may contribute to cisplatin-induced ototoxicity; although this association has not been consistent across populations and study designs.

The topics that should be addressed in a presentation about ototoxicity in oncology include:

• Definition and prevalence of ototoxicity in patients treated with cisplatin
• Risk factors for ototoxicity, such as prior or simultaneous cranial irradiation, age less than 5 years, treatment with other ototoxic drugs, and renal impairment
• Genetic factors that may contribute to cisplatin-induced ototoxicity
• Clinical manifestations of ototoxicity, including tinnitus, hearing loss, and vestibular toxicity
• Monitoring and prevention strategies, such as audiometric monitoring and peak plasma concentration management
• Reversibility of cisplatin-induced ototoxicity, which is currently unclear 2

From the Research

Topics to be Addressed in a Presentation about Ototoxicity in Oncology

The following topics should be addressed in a presentation about ototoxicity in oncology:

• Definition and prevalence of ototoxicity in cancer patients 3, 4, 5, 6, 7
• Causes and risk factors of ototoxicity, including platinum chemotherapy (cisplatin, carboplatin) and cranial radiation 3, 4, 6
• Clinical features and symptoms of ototoxicity, such as hearing loss and tinnitus 4, 5, 6
• Impact of ototoxicity on quality of life and socioeconomic consequences for cancer patients and survivors 3, 5, 6, 7
• Current management and treatment options for ototoxicity, including prevention, diagnosis, monitoring, and rehabilitation 3, 6, 7
• Emerging and established therapies for chemotherapy-induced ototoxicity, including otoprotection strategies 7
• Importance of interdepartmental communication between oncology and audiology services for optimal patient care 5
• Need for standardized ototoxicity management programs and policies to guide development of effective and feasible programs 3
• Research and evaluation of ototoxicity management, including the need for audiovestibular monitoring in clinical trials 4