Scalp cooling is changing the face of cancer, by helping thousands of people keep their hair while undergoing treatment for chemotherapy.
Cancer affects people in different ways, but one of the most traumatic side effects of chemotherapy is hair loss. The process can make a patient feel like they are losing control of their body and their appearance, at what is already an extremely difficult time in their life. Chemotherapy does not have to mean hair loss though, as many people across the UK and throughout the world are finding out after using a pioneering scalp cooling technology.
Developed in Huddersfield, the Paxman Scalp Cooling System is changing the face of cancer, by helping thousands of people keep their hair while undergoing treatment for chemo.1 Scalp cooling (the cold cap) can be used with all solid tumour cancers that are treated with chemotherapy drugs such as taxanes (e.g. docetaxel), alkylating agents (e.g. cyclophosphamide) and anthracyclines/DNA intercalating agents (e.g. doxorubicin). These drugs target rapidly dividing cells and the matrix keratinocytes, which results in hair loss.
Scalp cooling cannot be used with the following conditions:
For a successful treatment, the scalp needs to be maintained at a constant temperature. This is achieved by the correct fitting of the cap. Pre-cooling of the scalp takes 30 minutes prior to commencement of drug infusion. This ensures the scalp is at the required temperature before chemotherapy is administered. The cap should be worn throughout the administration of the chemotherapy drugs and for 90 minutes afterwards. The system requires minimal nursing supervision.
Cancer chemotherapy affects rapidly dividing cells and, at any given time, 90% of human hair follicles are in the actively dividing phase. Hair loss frequently occurs due to partial or total atrophy of the hair root bulb, causing constriction of the hair shaft, which then breaks off easily. Cell division is metabolism-driven – this process is decelerated by cooling. Also, a decrease in the metabolic activity of the cells in the hair follicle could cause a more general reduction in the cytotoxicity of chemotherapy drugs localised to the scalp.
Scalp cooling causes blood vessel vasoconstriction, which has been shown to reduce blood flow in the scalp to 20-40% of the normal rate, resulting in less chemotherapeutic drug being delivered to the hair follicles. The rate of drug diffusion across a plasma membrane is reduced – therefore lower effective drug doses may enter the cells. It is also suggested that reduced biochemical activity due to cooling makes hair follicles less vulnerable to the damage of chemotherapy agents.
Gregory et al² found that alopecia prevention occurred when scalp temperature was reduced below 22˚C and Bulow et al³ demonstrated that a subcutaneous temperature below 22˚C corresponds to an epicutaneous temperature of 19˚C. Results from these tests indicate that the equipment used in the study reduced scalp temperatures to an optimum constant level for alopecia prevention.
The level of success is determined by how well the scalp temperature is lowered and maintained throughout the treatment period. The Paxman cap has been specifically designed from lightweight silicone to help achieve this, and the equipment has been scientifically tested to prove its effectiveness.
Independent observational studies have demonstrated the safety and effectiveness of the Paxman Scalp Cooling System in the prevention of chemotherapy induced hair loss 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 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 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’.”
1 Paxman publication: Chemotherapy Induced Hair Loss.
2 Gregory RP, Cooke T, Middleton J, Buchanan RB, Williams CJ (1982) Prevention of doxorubicininduced 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 Invest1985, 45, 505-508
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