ONCOLOGY
with widely used chemotherapy dosages and regimens. All trials have reported high levels of patient comfort and acceptability, with low numbers of patients discontinuing scalp cooling.
Improving the patient experience
One clinician who understands more than others what scalp cooling means to the people who use it is Dundee healthcare support worker, Pam Fitzpatrick. For the last 13 years, Pam has worked at the chemotherapy day area at Ninewells Hospital – a centre that has been offering scalp cooling for over 18 years. Before embarking on a nursing career, Pam was a hairdresser, which she says has given her an insight into why people find chemotherapy-induced hair loss so traumatic. Pam said: “My previous experience has given me the foundation to understand the importance of hair and body image to people, especially when they are undergoing chemotherapy. It has also given me an acute awareness of the fear and distress that the thought of hair loss can cause. For some patients, hair loss is their biggest fear over and above other side effects of chemotherapy.” Pam explained that although scalp cooling is readily available across the UK, there is an inconsistency in people’s awareness and understanding of it. She hopes that by sharing her experience, more people will become aware of the treatment and its benefits. “It is extremely important that patients are provided with scalp cooling information and are able to make an informed choice as
Key study findings:
l United Kingdom Study – UK observational study reports an 89% success rate following use of the Paxman cold cap system in breast cancer patients, with only 11% with severe hair loss requiring wigs.
l Norway Study – Norwegian observational study reports a 92% success rate following use of the Paxman cold cap system in 54 breast cancer patients treated with FEC/FAC or paclitaxel.
l Netherlands Study 1 – Observational study reports a 40% reduction of head covers when using the Paxman cold cap system in breast cancer patients.
l Netherlands Study 2 – 88% of patients didn’t require a head cover or wig following 45 minutes post-infusion cooling after 3 weekly docetaxel.
l Netherlands Study 3 – 48% success rate in patients treated with different cancer types.
l Swiss Study – 93.7% patient assessment of scalp cooling was above reasonably well.
l Lebanese Study – 91.21% overall scalp cooling had excellent results in patients.
to whether they want to use it or not. Over the years, there have been great improvements in the technology of the machines and more research, which has led to an improved patient experience and an increase in its use. I feel very strongly that, where possible, all patients who are at risk of hair loss through chemotherapy, should be offered the chance to retain it,” she commented. Pam’s role involves explaining what scalp cooling is when patients attend for their pre-course assessment prior to their first chemotherapy and also measuring them for the correct size of cap. She also answers any questions or queries the patients may have. On the day of treatment, Pam will put the patient onto the scalp cooling machine. She wets and conditions their hair, places a headband over their forehead and ears, and then places the cold cap in a snug but comfortable position on their head and sets the machine to the correct time. Patient comfort is ensured throughout their treatment and time on the machine, by providing blankets. Pam explains that most people tolerate the cold cap reasonably well and the results are mostly very successful. She explains that some patients will experience hair thinning while using the cold cap, however it means they can still present themselves as visually ‘normal’ in their everyday lives. She added: “People tell me that they want to keep their hair for their children and it helps them get through the cancer journey. I think most importantly though, keeping their hair means they don’t have to tell everyone they have cancer and are undergoing chemotherapy. Being able to retain their hair means their body image is preserved and they can retain some sense of normality. Essentially, it goes a long way in helping them cope with their treatment.” The scalp cooling product was developed
by the Paxman family after they witnessed first-hand the devastating effects that losing hair can have on a loved one. Today, the scalp cooler has been used by over 100,000 patients in 32 countries and is responsible for helping patients to keep their hair and retain a feeling of normality during chemotherapy. Despite being used in over 90% of NHS hospitals in the UK, the public’s awareness of scalp cooling is still relatively low. It is
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estimated that only 10% of people know what scalp cooling is, and 8% of patients refuse chemotherapy because they don’t want to lose their hair. Claire Paxman, sales and training manager at Paxman, explained: “Scalp cooling is an option for people going through chemotherapy, but sadly there are so many people that have never heard of it. Others are put off from it because they have been given the wrong misconceptions of what it is actually like. We want to change this and are working hard to raise awareness.” Scalp cooling training is also high on the agenda and for the first time, there will be a scalp cooling master class at the next UKONS (UK Oncology Nursing Society) meeting. Held in February at the Guy’s Hospital
London, the session will discuss the importance of scalp cooling, examine the science behind it, the importance of the cap fitting and will have patient and clinical ‘pioneers’ to talk about their personal experiences.
As well as this, the company is also working with UK hospitals to deliver an in-depth clinical training programme so more people are trained on all aspects of the treatment including clinical data, hair care, troubleshooting and best practice assistance. Claire added: “It’s our aim that the training will not only help each clinician personally in their role but it will also allow them to become a ‘clinical pioneer’ – ensuring that scalp cooling treatment is being offered to patients and is being used correctly and efficiently. “Scalp cooling may not be for everyone but
it’s important that people at least know there is an alternative out there. Chemotherapy doesn’t automatically have to mean wigs or shaving your head and by working with clinicians we can help change this perception and together ‘change the face of cancer’.” CSJ
References
1 Paxman publication: Chemotherapy Induced Hair Loss. 2 Gregory RP, Cooke T, Middleton J, Buchanan RB, Williams CJ (1982) Prevention of doxorubicin- induced alopecia by scalp hypothermia; relation to degree of cooling. British Medical Journal 284, 1674.
3 Bulow J, Friberg L, Gaardsting O, Hansen M. Frontal subcutaneous blood flow, and epi and subcutaneous temperatures during scalp cooling in normal man. Scand J Clin Lam Invest 1985, 45, 505-508.
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