Identifying Gaps and Opportunities to Improve Ototoxicity Management in Veterans With Cancer: Evidence From a Retrospective Cohort and Oncology Provider Survey

TL;DR

This study finds that few Veterans receiving ototoxic chemotherapy get audiology care, despite providers' belief in its importance, highlighting a care gap.

Contribution

The study combines provider surveys and real-world data to identify barriers and opportunities for improving ototoxicity management in Veterans.

Findings

Less than 10% of Veterans on cisplatin accessed audiology services within a year of treatment.

Most providers believe ototoxicity management should be routine but rarely refer patients to audiology.

Access, perceived need, and resources were major barriers to ototoxicity management.

Abstract

Identify factors influencing audiological care for chemotherapy‐induced ototoxicity from the perspectives of oncology providers in the Veterans Health Administration (VA), and quantify audiology service use among Veterans receiving ototoxic chemotherapies.

We surveyed VA oncology providers to identify barriers and facilitators to ototoxicity management (OtoM). We also conducted a VA‐wide retrospective cohort analysis over a 5‐year period to quantify audiology service use among Veterans who received cisplatin, carboplatin, or oxaliplatin chemotherapy.

A total of 30,643 Veterans received platinum‐based chemotherapy from 2014 to 2019. Few of them (< 10% on cisplatin, < 5% on carboplatin or oxaliplatin) accessed audiology services within a year of treatment. Of the 8702 patients on cisplatin, only 9.6% had two or more audiology encounters. Thirty‐six oncology providers completed our survey. Most providers believed OtoM should be routine for patients on cisplatin (97%) or carboplatin (70%), but they overestimated audiology service provision levels relative to our analysis. Most providers would consider giving a different chemotherapy drug (73%) or decrease the dose (56%) for patients with ototoxicity, yet only 36% routinely referred patients to audiology. Access, perceived need, and resources were major barriers to OtoM, while care coordination was a primary facilitator.

OtoM is a care‐gap for Veterans with cancer, despite its perceived value to VA oncology providers. Cisplatin and carboplatin frequently add hearing loss and tinnitus to survivors' treatment burdens. This study offers insights into oncology providers' views on OtoM, guiding efforts to address the identified care gap.

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