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Special Communication
August 12, 2021

Recommendations for Age-Appropriate Testing, Timing, and Frequency of Audiologic Monitoring During Childhood Cancer Treatment: An International Society of Paediatric Oncology Supportive Care Consensus Report

Author Affiliations
  • 1Department of Pediatric Oncology, Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
  • 2Department of Pediatric Oncology, Erasmus Medical Center–Sophia Children’s Hospital, Rotterdam, the Netherlands
  • 3Department of Audiology and Speech Pathology, BC Children’s Hospital, Vancouver, British Columbia, Canada
  • 4School of Audiology and Speech Science, University of British Columbia, Vancouver, British Columbia, Canada
  • 5Department of Phoniatrics and Pedaudiology, University Hospital Muenster, Westphalian Wilhelm University, Muenster, Germany
  • 6Department of Pediatric Audiology, Oregon Health and Science University, Portland
  • 7Cancer and Blood Disease Institute, Children's Hospital Los Angeles, Los Angeles, California
  • 8Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles
  • 9Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles
  • 10Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles
  • 11Department of Otolaryngology, Stanford University School of Medicine, Palo Alto, California
  • 12Department of Pediatric Hematology–Oncology, Children’s Hospital, University of Cologne, Cologne, Germany
  • 13Department of Pediatric Hematology–Oncology, Agia Sofia Children's Hospital, Athens, Greece
  • 14Dana Farber/Boston Children’s Cancer and Blood Disorders Center, Harvard Medical School, Boston, Massachusetts
  • 15Department of Pediatric Oncology/Hematology/Immunology, Stuttgart Cancer Center, Olgahospital Stuttgart, Stuttgart, Germany
  • 16Department of Oncology, University College London Hospitals National Health Service Trust, London, United Kingdom
  • 17Department of Pediatric Oncology, Birmingham Children's Hospital, Birmingham, United Kingdom
  • 18Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
  • 19Department of Pediatric Hematology and Oncology, University Medical Center Hamburg, Hamburg, Germany
  • 20Division of Oncology, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio
  • 21Communication Sciences Research Center, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio
  • 22Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, Toronto, Canada
  • 23Department of Pediatric Hematology and Oncology, University Hospital Bonn, Bonn, Germany
  • 24BC Children’s Hospital Research Institute, Vancouver, British Columbia, Canada
  • 25Division of Translational Therapeutics, Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
  • 26Pharmaceutical Outcomes Programme, BC Children’s Hospital, Vancouver, British Columbia, Canada
  • 27Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Utrecht–Wilhelmina Children’s Hospital, Utrecht, the Netherlands
  • 28Department of Pediatrics, Section of Hematology–Oncology, Texas Children's Cancer and Hematology Centers, Houston, Texas
  • 29Department of Pediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
  • 30Kids Cancer Centre, Sydney Children's Hospital, High Street, Randwick, Australia
  • 31School of Women's and Children's Health, University of New South Wales Medicine, Sydney, Australia
  • 32Department of Pediatrics, Institute for Cancer Outcomes and Survivorship, School of Medicine, University of Alabama at Birmingham
  • 33Department of Pediatric Oncology, Great Ormond Street Hospital for Children National Health Service Trust, London, United Kingdom
  • 34Department of Audiovestibular Medicine and Cochlear Implant, Great Ormond Street Hospital for Children National Health Service Trust, London, United Kingdom
JAMA Oncol. Published online August 12, 2021. doi:10.1001/jamaoncol.2021.2697

Importance  Ototoxicity is an irreversible direct and late effect of certain childhood cancer treatments. Audiologic surveillance during therapy as part of the supportive care pathway enables early detection of hearing loss, decision-making about ongoing cancer treatment, and, when applicable, the timely use of audiologic interventions. Pediatric oncologic clinical practice and treatment trials have tended to be driven by tumor type and tumor-specific working groups. Internationally accepted standardized recommendations for monitoring hearing during treatment have not previously been agreed on.

Objective  To provide standard recommendations on hearing loss monitoring during childhood cancer therapy for clinical practice.

Methods  An Ototoxicity Task Force was formed under the umbrella of the International Society of Paediatric Oncology, consisting of international audiologists, otolaryngologists, and leaders in the field of relevant pediatric oncology tumor groups. Consensus meetings conducted by experts were organized, aimed at providing standardized recommendations on age-directed testing, timing, and frequency of monitoring during cancer treatment based on literature and consensus. Consensus statements were prepared by the core group, adapted following several videoconferences, and finally agreed on by the expert panel.

Findings  The consensus reached was that children who receive ototoxic cancer treatment (platinum agents, cranial irradiation, and/or brain surgery) require a baseline case history, monitoring of their middle ear and inner ear function, and assessment of tinnitus at each audiologic follow-up. As a minimum, age-appropriate testing should be performed before and at the end of treatment. Ideally, audiometry with counseling before each cisplatin cycle should be considered in the context of the individual patient, specific disease, feasibility, and available resources.

Conclusions and Relevance  This is an international multidisciplinary consensus report providing standardized supportive care recommendations on hearing monitoring in children undergoing potentially ototoxic cancer treatment. The recommendations are intended to improve the care of children with cancer and facilitate comparative research on the timing and development of hearing loss caused by different cancer treatment regimens.

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