Monitoring Ototoxicity in Cancer Patients Undergoing Platinum-Based Chemotherapy and Radiation in Saudi Arabia: Challenges and Solutions.

Purpose: Platinum-based chemotherapy and radiotherapy are cornerstone treatments for many cancers but carry a high risk of ototoxicity, leading to hearing loss, tinnitus, and balance dysfunction. Despite the benefits of monitoring in reducing long-term consequences, global uptake remains poor. This study provides the first national-level insight into ototoxicity monitoring for cancer patients in Saudi Arabia, aiming to identify service gaps and propose solutions to guide healthcare planning. Methods: Twenty-five oncology centers were evaluated. Data were collected via phone interviews with oncologists and audiologists, providing a comprehensive understanding of monitoring in clinical practice. Results: Findings highlight a concerning reality: institutions often fail to support even the most basic elements of ototoxicity monitoring. Practices varied considerably in the absence of formal policies, even within the same institution, depending on audiology service availability and oncologists' referral approaches. Adult referrals were rare, pediatric monitoring was inconsistent, and long-term follow-up was limited. Barriers included inadequate audiological resources, staff shortages, insufficient multidisciplinary coordination, limited audiologists' knowledge, and lack of guidelines. Conclusion: As decision-makers seek reliable national data to guide policies aligned with Vision 2030 health transformation goals, this study proposes policy-based solutions to strengthen ototoxicity monitoring and expand access to hearing rehabilitation services in Saudi Arabia. The study has inspired a collaborative initiative-currently being explored by the author with audiologists and oncologists across health sectors-to promote internal monitoring protocols in capable institutions and lay the groundwork for a future national ototoxicity monitoring program.