title: Proposed comprehensive ototoxicity monitoring program for VA healthcare (COMP-VA).
abstract: Prevention and rehabilitation of hearing loss and tinnitus, the two most commonly awarded service-connected disabilities, are high priority initiatives in the Department of Veterans Affairs (VA). At least 4,000 Veterans, most with significant hearing loss, will receive cisplatin this year, with more than half sustaining permanent hearing shift and nearly 40% developing new tinnitus. With improved survivability following cancer treatment, Veterans treated with cisplatin are approached with the dual goals of effective treatment and preserved quality of life. This article describes COMP-VA, a comprehensive ototoxicity monitoring program developed for VA patients receiving cisplatin. The program includes an individualized pretreatment prediction model that identifies the likelihood of hearing shift given cisplatin dose and patient factors. It supports both manual and automated hearing testing with a newly developed portable audiometer capable of performing the recommended procedures on the chemotherapy unit during treatment. It also includes objective methods for identifying outer hair cell changes and predicting audiogram changes using distortion-product otoacoustic emissions. We describe this program of evidence-based ototoxicity monitoring protocols using a case example to give the reader an understanding of how this program would be applied, along with a plan for future work to accomplish the final stages of program development.
authors.affiliation: Portland VA Medical Center, National Center for Rehabilitative Auditory Research, 3710 SW US Veterans Hosp Rd, P5-NCRAR, Portland, OR 97239. dawn.martin@va.gov.
authors.forename: Dawn
authors.initials: D
authors.lastname: Konrad-Martin
authors.forename: Kelly M
authors.initials: KM
authors.lastname: Reavis
authors.forename: Garnett
authors.initials: G
authors.lastname: McMillan
authors.forename: Wendy J
authors.initials: WJ
authors.lastname: Helt
authors.forename: Marilyn
authors.initials: M
authors.lastname: Dille
mesh_terms: D019540:Area Under Curve; D001301:Audiometry, Pure-Tone / Q000379:methods; D001309:Auditory Threshold; D002294:Carcinoma, Squamous Cell / Q000150:complications / Q000188:drug therapy / Q000556:secondary; D002945:Cisplatin / Q000633:toxicity*; D019317:Evidence-Based Medicine; D034381:Hearing Loss / Q000139:chemically induced* / Q000175:diagnosis / Q000517:prevention & control* / Q000534:rehabilitation; D006320:Hearing Tests; D006801:Humans; D008297:Male; D008875:Middle Aged; D018670:Monitoring, Ambulatory / Q000379:methods* / Q000706:statistics & numerical data; D017084:Otoacoustic Emissions, Spontaneous; D016730:Program Development; D011788:Quality of Life; D012372:ROC Curve; D018570:Risk Assessment; D014012:Tinnitus / Q000139:chemically induced* / Q000175:diagnosis / Q000517:prevention & control* / Q000534:rehabilitation; D014062:Tongue Neoplasms / Q000188:drug therapy; D014067:Tonsillar Neoplasms / Q000188:drug therapy; D014481:United States; D014728:Veterans
chemical_list: D002945:Cisplatin
keywords: COMP-VA; DPOAE; OtoID; aural rehabilitation; chemotherapy; cisplatin; distortion-product otoacoustic emissions; hearing; ototoxicity monitoring; sensitive range for 
  ototoxicity