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SIOP scale best detects ototoxicity in children who receive cisplatin chemotherapy
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The Society for Industry and Organizational Psychology Ototoxicity Scale, or SIOP, appeared superior to three other scales in identifying ototoxicity among children who received cisplatin chemotherapy, study data show.
SIOP outperformed the American Speech-Language-Hearing Association (ASHA) scale, Common Terminology Criteria for Adverse Events (CTCAE) scale and the Brock Ototoxicity Grades (Brock).
“Cisplatin is a well-established chemotherapeutic agent that is used for several forms of childhood cancer, but its dose-limiting toxicity is hearing loss,” Kristin R. Knight, MD, assistant professor of audiology and director of pediatric audiology at the Child Development and Rehabilitation Center at Oregon Health and Science University in Portland, and colleagues wrote. “Irreversible hearing loss occurs in approximately two-thirds of children who are treated with cisplatin and is almost universal in specific subsets, such as young children with neuroblastoma, who are treated with cisplatin and carboplatin. International standardization in the assessment and reporting of ototoxicity for pediatric patients with cancer would advance patient care and ototoxicity research.”
The Children’s Oncology Group ACCL05C1 study evaluated the feasibility and efficacy of four ototoxicity scales. Researchers enrolled patients (n = 284; age range, 1-30 years; median age, 10.2 years) who were treated with cisplatin at 53 institutions between May 2007 and February 2012.
Knight and colleagues conducted audiologic evaluations at baseline, within one week of each subsequent cisplatin treatment and at end of treatment — approximately four weeks after cisplatin or hematopoietic stem cell transplantation. Testing audiologists, along with two central reviewing audiologists, assessed and graded test results.
The median cisplatin dose was 395 mg/m2. Twenty-seven patients received hematopoietic stem cell transplantation.
Overall prevalence of ototoxicity detected with any scale ranged from 40% to 56%. Severe ototoxicity prevalence ranged from 7% to 22%.
The SIOP scale detected significantly more ototoxicity than the CTCAE scale (P = .004). The Brock scale detected fewer instances of both ototoxicity and severe ototoxicity (P < .001 for both).
The SIOP scale also detected ototoxicity earlier than all other scales, followed by ASHA, CTCAE and Brock. ASHA and SIOP produced the most false positives, and the Brock scale produced the fewest.
The researchers noted that the study was limited because SIOP was developed after the trial had already begun, making it impossible to evaluate its inter-rater reliability. Further, the study could not examine sensitivity or specificity because there is no “gold standard” for measuring ototoxicity.
“In conclusion, SIOP may be superior to ASHA, Brock and CTCAE scales for classifying ototoxicity in pediatric patients who are treated with cisplatin,” Knight and colleagues wrote. “Future studies should evaluate inter-rater reliability of the SIOP scale.” – by Andy Polhamus
Disclosure: Knight reports no relevant financial disclosures. Please see the full study for a list of all other researchers’ relevant financial disclosures.
Perspective
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The overall survival of pediatric cancer patients has improved dramatically with more effective treatment regimens. Thus, the ramifications of long-term side effects are becoming increasingly apparent. Sensorineural hearing loss, or permanent deafness, has been an obstacle for any child treated with cisplatin, a commonly used chemotherapy within pediatric oncology.
With improved outcome comes the need for improved monitoring to prevent such toxicities. Hearing loss in a small child can affect language acquisition and neurocognitive development and even mild degrees of impairment can negatively impact older children in social communication and school performance. The stigma of using amplification systems and other hearing-aid devices affects the psychological outcome of all ages and is a long-term economic burden on families and society. This study compared the Society for Industry and Organizational Psychology ototoxicity criteria to the Common Terminology Criteria for Adverse Events, Brock Ototoxicity Grades, and American Speech-Language-Hearing Association scales and was found to be superior in detecting hearing loss. This is a potential leap in improving long-term outcome in survivors if validated in a larger cohort. The ability to detect clinically relevant hearing loss earlier empowers providers to change chemotherapy regimens and potentially reduce the need for hearing and sound devices.
A standard ototoxicity scale accepted by the international pediatric oncology community can unify the ability to detect hearing loss in all protocols. As hearing loss has a larger impact on the neurocognitive development of children than adults, having a gold standard scale can help reduce this long-term morbidity. Improved detection and further research into otoprotective agents can provide children the best opportunities in their neurodevelopmental and social outcome as they survive and thrive after cancer.
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