Episode 384: Learn About Scalp Cooling for Chemotherapy-Induced Alopecia

“Chemotherapy-induced alopecia does cause a lot of stress. It’s associated with lower quality of life. Scalp cooling may really help improve quality of life. Some studies have shown that women in the scalp cooling group felt less upset about losing their hair and less dissatisfied with their appearance compared to the women in the control group that didn’t receive any scalp cooling. So a lot of these studies are showing it does have a very positive impact on psychosocial feelings and side effects in relation to overall cancer treatment,” ONS member Jaclyn Andronico, MSN, CNS, OCN^®, AOCNS^®, clinical nurse specialist at Memorial Sloan Kettering Cancer Center in New York, NY, told Jaime Weimer, MSN, RN, AGCNS-BS, AOCNS^®, manager of oncology nursing practice at ONS, during a conversation about chemotherapy-induced alopecia and scalp cooling.

The advertising messages in this episode are paid for by Paxman. ONS is solely responsible for the criteria, objectives, content, quality, and scientific integrity of its programs and publications.

Music Credit: “Fireflies and Stardust” by Kevin MacLeod

Licensed under Creative Commons by Attribution 3.0 

Episode Notes 

• This episode is not eligible for NCPD.
• ONS Podcast™ Episode 250: Cancer Symptom Management Basics: Dermatologic Complications
• ONS Voice articles:
• Diagnose and Manage Dermatologic Toxicity Secondary to Immunotherapy
• Follow the Evidence When Using Scalp Cooling for Cancer Alopecia
• Reimbursements Are Making Scalp Cooling More Accessible for Patients With Cancer
• The Case of the CIA-Combatting Combination
• ONS Voice oncology drug reference sheets:
• Docetaxel
• Doxorubicin Hydrochloride
• Sacituzumab Govitecan-Hziy
• ONS Guidelines™ for Cancer Treatment-Related Skin Toxicity
• Clinical Journal of Oncology Nursing articles:
• Chemotherapy-Induced Alopecia: Examining Patient Perceptions and Adherence to Home Haircare Recommendations
• Scalp Cooling: Implementing a Cold Cap Program at a Community Breast Health Center
• Scalp Cooling: Implementation of a Program at a Multisite Organization
• Oncology Nursing Forum articles:
• Effectiveness, Safety, and Tolerance of Scalp Cooling for Chemotherapy-Induced Alopecia
• The Effect of Chemotherapy-Induced Alopecia on Distress and Quality of Life in Male Patients With Cancer
• ONS Altered Body Image Huddle Card
• Journal of Market Access and Health Policy article: Expanding the Availability of Scalp Cooling to All Patients at Risk of Chemotherapy-Induced Alopecia
• HairToStay
• Paxman patient assistance program
• Rapunzel Project

To discuss the information in this episode with other oncology nurses, visit the ONS Communities.

To find resources for creating an ONS Podcast club in your chapter or nursing community, visit the ONS Podcast Library.

To provide feedback or otherwise reach ONS about the podcast, email [e-mail].

Highlights From This Episode

“Some of the classes that are high risk for chemotherapy-induced alopecia can include antitumor antibiotics, such as doxorubicin, epirubicin; antimicrotubule drugs, such as taxanes like docetaxel, paclitaxel; alkylating agents such as cyclophosphamide. The lower risk alopecia-causing chemo agents are the antimetabolite classes, which a lot of people know as gemcitabine or fluorouracil. We also are seeing patients experience some degree of alopecia with a drug called sacituzumab govitecan, which is an actual antibody–drug conjugate.” TS 2:09

“Scalp cooling is approved for solid tumor patients. Patients receiving chemotherapy agents, as we discussed before, with that high incidence of chemotherapy-induced alopecia really should be considered for scalp cooling as long as they don’t have certain contraindications. Some contraindications do exist for these populations. Those are patients that have cold agglutinin diseases, cryoglobulinemia, cryofibrinogenemia, and any cold sensitivity issues. Patients also with abnormal liver functions are not suggested to receive scalp cooling because their liver function is associated with the metabolism of the drug agent. It’s also not recommended for patients with hematologic malignancies who are higher risk for cutaneous metastatic disease or failed chemotherapy and even reduced survival rates.” TS 9:23

“Overall, scalp cooling has a good tolerance, but it’s important to be aware that scalp cooling can be uncomfortable for some, and it isn’t always tolerated by some patients. Patients have reported side effects such as headaches, dizziness, chills, cold sensations, scalp pain, head discomfort, and even claustrophobia. Among these, the most common is the cold feeling and headaches. So when caring for patients that undergo scalp cooling, the nurses really should recognize the patient’s feelings and help relieve that discomfort with position changes, prophylactic painkillers such as [acetaminophen] or [ibuprofen] if they’re allowed to take that, additional warm blankets. Even antianxiety medications can really help, especially if that claustrophobia feeling is there. So collaborating with that team, the doctors, the nurse practitioners, just to be aware that if the patient’s not comfortable during this treatment of scalp cooling, they should have those things on board prior to starting.” TS 12:23

“A lot of primary education points for nurses to review with patients is explaining the financial reimbursement process and assistance options—collaborating with that financial department within your institution. Also discussing the efficacy of the scalp cooling and the tolerability of it as well. I don’t know if patients are always aware of the feeling of the cold—really warning them, letting them know what they’re going to experience while in the chair attached to that cooling machine.” TS 18:55

“Nurses, we’re at the forefront of scalp cooling, and we manage a lot of this area that comes with the service. They are managing, the coordination of the care, the education. They’re assisting with that financial discussion and collaborating with the financial department. The symptom management—they’re helping make the patients feel more comfortable with the symptoms of scalp cooling. They are the real deal here, so they are the best in helping with the situation. Nurses should be really familiar with the efficacy, again, and the tolerability, the contraindications, the side effects, and the costs and even the access for scalp cooling.” TS 20:57