Routine early screening for chemotherapy-induced hearing loss and other neuropathies in patients undergoing cancer treatment: a pilot study

Objectives: Neuropathies are well-recognized and potentially long-lasting complications of chemotherapy. The purpose of this study was to evaluate the feasibility and potential utility of routinely screening in patients undergoing cancer treatment for chemotherapy-induced neuropathies including: hearing loss (CIHL), peripheral neuropathy (CIPN), and cognitive impairment (CICI). Methods: After obtaining Institutional Review Board (IRB) approval five registered nurses were trained to conduct this prospective observational cohort study. Patients were recruited and consented after being scheduled to receive taxane or platinum based chemotherapy regimens. Prior to each chemotherapy infusion, subjects were invited to undergo on-site, portable automatic iPad-based air-conduction hearing testing and complete questionnaires assessing symptoms associated with peripheral neuropathy (CIPNAT: Chemotherapy-induced peripheral neuropathy assessment tool) and cognitive impairment (AFI: Attentional function index). Descriptive statistics were used to summarize study data. Results: A total of 20 subjects were enrolled. Each subject was able and willing to complete screenings and assessments prior to their chemotherapy infusion. Over 6 months, 2 subjects subjectively reported tinnitus and/or hearing impairment, which subsequently discontinued their chemotherapy. Both were unable to complete auditory testing due to tinnitus-associated pain induced by testing. In addition, objective evidence of auditory impairment was detected in another 7/16 subjects who denied subjective auditory symptoms. No improvements in CIHL were observed after subjects (n=6) had a treatment delay. A total of 65 percent (n=13) of subjects reported subjectively experiencing at least one symptom of peripheral neuropathy (CIPN). This was observed as early as the first cycle of chemotherapy (n=6), after which the proportion of subjects experiencing CIPN increased. After the third treatment, the total number of subjects (n=10) experiencing CIPN reported a decrease as dose reductions and/or treatment delays were initiated. All subjects (20/20) reported evidence of cognitive impairment (CICI) that progressively worsened over their treatment course. No improvements in CIHL or CICI were observed following dose reductions/delays or pyridoxine use. Conclusions: Routine on-site screening for chemotherapy-induced neuropathies in patients receiving chemotherapy for cancer treatment is feasible. Importantly, these screenings can uncover otherwise unappreciated complications, such as hearing loss and impaired cognition. Given that neither CIHL or CICI improved following treatment delays or pyridoxine use, routine screening may allow for the early implementation of therapies to blunt the impact of long-lasting side effects which lead to decreased quality of life.