Advancing Education, Research, and Quality of Care for the Head and Neck oncology patient.
Introduction: Cisplatin and radiation are commonly used in head and neck (H&N) cancer treatment, but they also cause irreversible hearing loss and tinnitus in more than 40% of treated patients. Although auditory rehabilitation has been standard-of-care against ototoxicity for decades, only 10% of H&N cancer survivors pursue audiologic follow-up after six months. The present study evaluates the effectiveness and feasibility of a novel point-of-care ototoxicity screening protocol embedded within H&N cancer survivorship clinic to improve audiology follow-up.
Methods: A non-randomized single-arm trial was conducted on survivors of H&N cancer treated with radiation +/- cisplatin-based chemotherapy. The screening protocol was implemented within a H&N cancer survivorship clinic at a National Cancer Institute-designated cancer center during clinic appointments. The screening protocol included the Hearing Handicap Inventory for the Elderly – Screening Version (HHIE-S), a validated 10-question instrument for screening functional impairment related to hearing loss, and pure tone audiometry (40-decibel tone at 2 kHz to each ear) administered via tablet-based software. A failed screen was defined as HHIE-S score greater than or equal to 10 or no pure tone response for either ear. The primary outcome was rate of audiology follow-up within 6 months after their survivorship clinic appointment. Secondary outcomes included validated patient-reported outcomes related to screening protocol implementation, H&N survivorship (University of Washington Quality of Life Questionnaire; UW-QOL), and hearing-related function (Self-Efficacy for Situational Communication Management Questionnaire; SESMQ).
Results: Sixty patients were enrolled, and 56 patients were analyzed. The mean age of the cohort was 64 years. The rate of 6-month audiologic follow up for the entire cohort was 33.9% (95% CI = 21.8% to 47.8%). Participants that failed the ototoxicity screening protocol sought out audiologic follow-up at a rate of 38.1% (95% CI = 18.1% to 61.6%), compared to 31.4% (95% CI = 16.9% to 49.3%) among those who passed the screen. Participants who failed the screen reported more severe ototoxicity and less confidence in different listening situations than those who passed the screen. The most reported treatment-related toxicities that were considered important by participants were tinnitus (n = 12/35, 34.3%), dysphagia (n = 12/35, 34.3%), and decreased activity (n = 9/35, 25.7%). These frequencies were closely followed by hearing loss (n = 8/35, 20.0%), which was reported at the same rate as xerostomia and chronic pain. Ototoxicity, defined as either hearing loss or tinnitus, was considered important by 45.7% of participants (n = 17/35). However, there were no significant differences in UW-QOL global scores of health-related and overall QOL among participants that considered ototoxicity as important compared to those who did not (global QOL: 1.1, 95% CI = -13.2 to 15.6; 2.6, health-related QOL: 95% CI = -12.8 to 18.1). Patients considered the ototoxicity screening protocol to be feasible, acceptable, and appropriate according to validated implementation surveys.
Conclusion: Ototoxicity is among the most important treatment-related side effects reported by patients. A point-of-care ototoxicity screening protocol implemented within H&N cancer survivorship clinic is feasible and may increase rate of audiologic follow-up.