PATIENT CARE
l Follow up information: dependent on availability and willingness of the patient to be contacted six months after treatment to evaluate hair growth and results to determine incidence of persistent hair loss.
This data will inform clinicians about the added value of scalp cooling, its effectiveness per type of chemotherapy, and also about the factors attributing to why it may be successful for one patient but not for another. The damage that chemotherapy causes to the hair follicle can be alleviated by using scalp cooling, also known as the ‘cold cap’. During scalp cooling treatment, a tight-fitting silicone cooling cap is placed directly on the head, and an outer neoprene cap that insulates and secures the silicone cap. The cooling cap is connected to a cooling and control unit. A liquid coolant circulates throughout the silicone cap, delivering consistent and controlled cooling to all areas of the scalp. Once the cap is fitted to the head, the temperature of the scalp skin is significantly lowered, resulting in vasoconstriction with reduced delivery of chemotherapy to the scalp skin, as well as reduced cellular uptake of drugs due to decreased intra-follicular metabolic rate. Together, these factors minimise the hair loss that is a side effect of many chemotherapy agents. The fit of the cap is the crucial factor. CHILL executive board member Dr Corina van den Hurk, added that scalp cooling is
well-recognised around the globe as a therapeutic solution to one of the most troublesome side effects of chemotherapy. “Over the last 10 years, hair loss has consistently been ranked as one of the worst side effects from patients, but things are changing and we are taking control of it through scalp cooling,” said Dr van den Hurk, a researcher in clinical oncology and epidemiology at the Netherlands Comprehensive Cancer Organisation. “There is more and more attention for quality of life and it is clear that worldwide, the use of scalp cooling increases exponentially. Offering patients the option of scalp cooling doesn’t just treat the side effect
The UK is behind the Ne therlands in implementing scalp cooling in the NHS, despite having the highest number of machines of any country.
of chemotherapy-induced hair loss, it also helps people psychologically and socially. It helps them stay in control at what can be one of the most distressing times of their lives.”
Developing best practice
Dr van den Hurk added that the launch of the CHILL Registry is a significant step forward as global clinicians work together to develop best practices in supportive care. “There are many variables in scalp cooling, and they are increasing all the time,” she said. “For instance, when we looked, we found that there were more than 30 different scoring methods used in different studies about scalp cooling. This is just an example of how variable the information is, but if we collate all of this data we can present them to patients and doctors in a more useful way, to help inform their treatment decisions. “The effectiveness of scalp cooling depends on type and dose of chemotherapy, and there are many cytotoxics and
A number of cancer centres in the UK offer scalp cooling to women and men who will lose their hair because of chemotherapy.
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combinations of them. This means high numbers of patients are needed to evaluate results and its determining factors. Moreover, if you want to compare results between hospitals, it is desirable to have dozens of patients with one type and dose of chemotherapy per hospital to make reliable estimations. “There are also constantly new chemotherapies on the market so it is helpful to have as many centres involved in the registry as possible so patients can be informed about the added value of scalp cooling as early as possible.” The registry also provides the opportunity to detect best practices. Centres around the globe that have previously not had positive scalp cooling results can learn from others, which have, to help improve future scalp cooling success for its patients. It was set up following the success of the Dutch registry on alopecia which includes the details of several thousand patients already. It shows that, even
JUNE 2018
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