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Abstract：
To promote establishment of effective ototoxicity monitoring programs (OMPs), this report reviews the U.S. national audiology guidelines in relation to \"real world\" OMP application. Background is provided on the mechanisms, risks and clinical presentation of hearing loss associated with major classes of ototoxic medications.
This is a non-systematic review using PubMed, national and international agency websites, personal communications between ototoxicity experts, and results of unpublished research. Examples are provided of OMPs in various healthcare settings within the U.S. civilian sector, Department of Defense (DoD), and Department of Veterans Affairs (VA).
The five OMPs compared in this report represent a convenience sample of the programs with which the authors are affiliated. Their opinions were elicited via two semi-structured teleconferences on barriers and facilitators of OMP, followed by a self-administered questionnaire on OMP characteristics and practices, with responses synthesized herein. Preliminary results are provided from an ongoing VA clinical trial at one of these OMP sites. Participants were 40 VA patients who received cisplatin chemotherapy in 2014-2017. The study arms contrast access to care for OMP delivered on the treatment unit versus usual care as provided in the audiology clinic.
Protocols of the OMPs examined varied, reflecting their diverse settings. Service delivery concerns included baseline tests missed or completed after the initial treatment, and monitoring tests done infrequently or only after cessation of treatment. Perceived barriers involved logistics related to accessing and testing patients, such as a lack of processes to help patients enter programs, patients\' time and scheduling constraints, and inconvenient audiology clinic locations. Use of abbreviated or screening methods facilitated monitoring.
The most effective OMPs integrated audiological management into care pathways of the clinical specialties that prescribe ototoxic medications. More OMP guidance is needed to inform evaluation schedules, outcome reporting, and determination of actionable ototoxic changes. Guidance is also lacking on the use of hearing conservation approaches suitable for the mass testing needed to support large-scale OMP efforts. Guideline adherence might improve with formal endorsement from organizations governing the medical specialty stakeholders in OMP such as oncologists, pulmonologists, infectious disease specialists, ototolaryngologists and pharmacists.
This is a non-systematic review using PubMed, national and international agency websites, personal communications between ototoxicity experts, and results of unpublished research. Examples are provided of OMPs in various healthcare settings within the U.S. civilian sector, Department of Defense (DoD), and Department of Veterans Affairs (VA).
The five OMPs compared in this report represent a convenience sample of the programs with which the authors are affiliated. Their opinions were elicited via two semi-structured teleconferences on barriers and facilitators of OMP, followed by a self-administered questionnaire on OMP characteristics and practices, with responses synthesized herein. Preliminary results are provided from an ongoing VA clinical trial at one of these OMP sites. Participants were 40 VA patients who received cisplatin chemotherapy in 2014-2017. The study arms contrast access to care for OMP delivered on the treatment unit versus usual care as provided in the audiology clinic.
Protocols of the OMPs examined varied, reflecting their diverse settings. Service delivery concerns included baseline tests missed or completed after the initial treatment, and monitoring tests done infrequently or only after cessation of treatment. Perceived barriers involved logistics related to accessing and testing patients, such as a lack of processes to help patients enter programs, patients\' time and scheduling constraints, and inconvenient audiology clinic locations. Use of abbreviated or screening methods facilitated monitoring.
The most effective OMPs integrated audiological management into care pathways of the clinical specialties that prescribe ototoxic medications. More OMP guidance is needed to inform evaluation schedules, outcome reporting, and determination of actionable ototoxic changes. Guidance is also lacking on the use of hearing conservation approaches suitable for the mass testing needed to support large-scale OMP efforts. Guideline adherence might improve with formal endorsement from organizations governing the medical specialty stakeholders in OMP such as oncologists, pulmonologists, infectious disease specialists, ototolaryngologists and pharmacists.
摘要：
促进建立有效的耳毒性监测计划（OMPs），本报告回顾了与“真实世界”OMP应用相关的美国国家听力学指南。提供了有关机制的背景，与主要类型的耳毒性药物相关的听力损失的风险和临床表现。
这是使用PubMed进行的非系统审查，国家和国际机构网站，耳毒性专家之间的个人沟通，和未发表的研究结果。在美国民用部门的各种医疗保健环境中提供了OMP的例子，国防部（DoD），退伍军人事务部（VA）。
本报告中比较的五个OMP代表了作者所属程序的便利样本。他们的意见是通过两次关于OMP障碍和促进者的半结构化电话会议引起的，随后是一份关于OMP特征和做法的自我管理问卷，与本文合成的响应。在这些OMP位点之一进行的VA临床试验提供了初步结果。参与者为2014-2017年接受顺铂化疗的40例VA患者。该研究小组将在治疗单元上提供的OMP护理与听力学诊所提供的常规护理进行了对比。
所检查的OMP的协议各不相同，反映了他们多样化的环境。服务交付问题包括初始治疗后错过或完成的基线测试，很少或只在停止治疗后进行监测测试。感知到的障碍涉及与获取和测试患者相关的物流，例如缺乏帮助患者进入项目的程序，患者的时间和调度限制，和不方便的听力学诊所位置。使用缩写或筛选方法有助于监测。
最有效的OMPs将听力学管理整合到处方耳毒性药物的临床专科的护理路径中。需要更多的OMP指导来告知评估时间表，结果报告，并确定可行的耳毒性变化。对于使用适合支持大规模OMP工作所需的大规模测试的听力保护方法，也缺乏指导。随着管理OMP医学专业利益相关者的组织的正式认可，如肿瘤学家，肺病学家,传染病专家,耳鼻喉科医师和药剂师。
这是使用PubMed进行的非系统审查，国家和国际机构网站，耳毒性专家之间的个人沟通，和未发表的研究结果。在美国民用部门的各种医疗保健环境中提供了OMP的例子，国防部（DoD），退伍军人事务部（VA）。
本报告中比较的五个OMP代表了作者所属程序的便利样本。他们的意见是通过两次关于OMP障碍和促进者的半结构化电话会议引起的，随后是一份关于OMP特征和做法的自我管理问卷，与本文合成的响应。在这些OMP位点之一进行的VA临床试验提供了初步结果。参与者为2014-2017年接受顺铂化疗的40例VA患者。该研究小组将在治疗单元上提供的OMP护理与听力学诊所提供的常规护理进行了对比。
所检查的OMP的协议各不相同，反映了他们多样化的环境。服务交付问题包括初始治疗后错过或完成的基线测试，很少或只在停止治疗后进行监测测试。感知到的障碍涉及与获取和测试患者相关的物流，例如缺乏帮助患者进入项目的程序，患者的时间和调度限制，和不方便的听力学诊所位置。使用缩写或筛选方法有助于监测。
最有效的OMPs将听力学管理整合到处方耳毒性药物的临床专科的护理路径中。需要更多的OMP指导来告知评估时间表，结果报告，并确定可行的耳毒性变化。对于使用适合支持大规模OMP工作所需的大规模测试的听力保护方法，也缺乏指导。随着管理OMP医学专业利益相关者的组织的正式认可，如肿瘤学家，肺病学家,传染病专家,耳鼻喉科医师和药剂师。
