Hearing the Gap: Why Cisplatin Ototoxicity Prevention Remains Unfinished Business in Pediatric Oncology

Ototoxicity Burden

When clinicians classified their patients by SIOP grade, approximately 77% were assigned some degree of hearing loss — 26% minor (SIOP 1), 26% high-frequency (SIOP 2), and 25% severe (SIOP 3-4). Only 22% of patients overall were estimated to have no hearing loss.

Awareness vs. Action Gap

Clinicians rated their concern at a mean of 6.07 out of 7, yet the dominant management approach remained reactive: 48% primarily monitored high-risk patients for early symptoms, and one in five patients (20%) received no preventive management at all.

Risk Stratification Insights

All 75 respondents reported conducting pre-treatment risk stratification. Clinicians estimated 28% of patients as low risk, 35% as moderate risk, and 37% as high risk, with expected hearing loss rates rising from 28% in low-risk to 47% in high-risk patients.

Prevention vs. Monitoring Patterns

Only 32% of clinicians reported using preventive techniques in most or all patients. France is the most reactive market (60% monitoring only); Germany the most proactive (32% using prevention in most patients).

Sodium Thiosulfate Adoption Signals

STS in some form dominated pharmacological prevention, with 64% of pharmacologically managed patients receiving it — 68% in France, 66% in Germany, and 57% in the United Kingdom.

Anticipated Cisplatin Use

Sixty percent of clinicians expected cisplatin use to increase over the next five years, with a mean anticipated magnitude of 16.9%, expanding the at-risk population and amplifying the urgency of effective preventive strategies.

Unmet Need

Clinicians rated unmet need at a mean of 5.76 out of 7 overall — Germany, 6.08; France, 5.72; United Kingdom, 5.48 — confirming a moderate-to-high unmet need across all three markets regardless of current practice patterns.