Why Every Patient Should Be Offered Cold Cap Therapy

Every patient with cancer should be offered cold cap therapy, according to Mary Heery, AOCNS, CBCN, APRN, a breast cancer navigator at The Smilow Family Breast Health Center at Norwalk Hospital in Norwalk, CT. Scalp cooling devices can provide patients with an opportunity to prevent hair loss during their chemotherapy treatments, and to potentially finish treatment without anyone else knowing about it. For some patients going through chemotherapy, this is invaluable.

At the 2021 AONN+ 12th Annual Navigation & Survivorship Conference, Ms Heery shared her advice and insights from starting a successful scalp cooling program at her own institution and armed navigators with the tools to do the same.

“You, as an individual, can start this at your institution, and it will become a success,” she told attendees. “Feel empowered by this information, and know that it will impact the lives of many people going through chemotherapy in the 2020s.”

Getting Started

According to Ms Heery, a successful scalp cooling program must be a multi-institution endeavor. It only requires 1 person to take the lead, but it is crucial that the hospital sees the cost value of the program, and that providers buy into it.

“By now, your physician and mid-level provider should have heard about scalp cooling, but if not, that’s okay,” she said. “Your job is to inform them.”

Patients must also be motivated to receive it, and their success completely depends on education. “If the patient doesn’t know the rules to play by,” she noted, “there will be hair loss and the perception that the caps don’t work.”

If the hospital pushes back about the cost of setting up a scalp cooling program, point out the revenue generated by just 1 patient receiving chemotherapy, she advised, and remind them it only takes 1 person to come to the institution and administer scalp cooling to patients. However, protocols must be put in place, and infectious disease and engineering departments must be involved to make sure everything is safe and running smoothly.

While the income might be the driving force for many institutions, it also gives a hospital or practice a competitive edge. “That’s how we first heard about it: a patient wanted to go to a different institution because we didn’t have cold cap therapy,” she said. “Well, we got on that as fast as we could.”

Staffing and Provider Education

According to Ms Heery, the importance of a coordinator cannot be overstressed. This person is vital to communicating with companies—like Paxman or DigniCap—getting patients in (also conducting daily scheduling of patient/nurse ratios), getting payments generated (also helping with financial assistance/grants), getting the product delivered, and documenting success and patient satisfaction.

“You may have to spend a little bit of time convincing administration to hire a coordinator, but she or he is well worth every penny,” she added.

Both patient and provider education play a huge role in making a scalp cooling program successful. Physicians and mid-level providers should be educated on when to pitch the program to patients, the success rates, and the referral process. “We need to give them 1 or 2 lines that they can communicate to patients about how effective it is,” she said.

They should also be able to assess their patients’ level of understanding and commitment, while also providing verbal and printed guidelines. “And if your institution doesn’t have a program set up yet and a patient is motivated to get started, they can call a company like Penguin Cold Caps and get started all on their own,” she noted.

Encourage providers to refer patients to nursing for more in-depth education—how scalp cooling will make them feel, if any medication will be administered, how to deal with any side effects (like headaches), etc.

Patient Education Is Crucial

“Patient education is an absolute must,” said Ms Heery. “If you don’t ask the patient what the value of their hair is, and if they are committed to taking care of their hair—but really, in essence—not taking care of their hair, it’s not going to be successful.”

Patients undergoing scalp cooling should wash their hair only once a week with sulfate-free shampoo. Coloring/highlighting is off-limits (but since hair follicles are being frozen, remind them that hair growth will be stunted). They should wash their hair in the sink, gently using their fingertips, and should use a wide-tooth comb. Essentially, patients should avoid touching their hair as much as possible (including putting it back in a ponytail with a hair tie or scrunchie, as this could pull the hair out).

“It’s a big commitment on the patient to follow the rules,” she said. “And the rules really are minimal care to their hair.”

But, when the rules are followed, these programs can be incredibly successful. According to Ms Heery, between 84% and 88% of the patients with breast cancer in their program have maintained more than 50% of their hair.

“Even with AC-T chemo [doxorubicin and cyclophosphamide followed by paclitaxel], where we automatically know that patients are going to lose their hair, we’ve had greater than 64% of hair retention,” she said. “That’s phenomenal.”

Additionally, recent research has shown that even if patients do lose more than 50% of their hair, continuing with cold cap therapy until the very end of treatment will allow their hair to grow back faster.

Do Not Forget Extremity Cooling

Finally, according to Ms Heery, extremity cooling is just as important as scalp cooling.

Certain regimens can cause people to lose their nails, but more importantly, extremity cooling can help patients avoid potentially lifelong neuropathic pain and discomfort. Patients can buy mittens and booties online to wear during their cold cap therapy, but if they don’t have them, simply have them put their fingertips and toes in cold water with a few pieces of ice, she advised.

“By just doing this, you’re going to stop or reduce the neuropathy issues that plague many, many people after chemotherapy,” she said.