Manual Scalp Cooling in Early Stage Breast Cancer: Value of Caretaker Training and Patient-Reported Experience to Optimize Efficacy and Patient Selection

Authors

Manaz Rezayee, Providence Portland Medical CenterFollow
Nikki Moxon, Earle A. Chiles Research Institute, Providence Portland Medical Center, Portland, ORFollow
Staci Mellinger, Earle A. Chiles Research Institute, Portland, OR; Providence Cancer Institute, Portland, ORFollow
Amanda Y Seino, Medical Oncology, Earle A. Chiles Research Institute, Providence Cancer InstituteFollow
Nicole E. Fredich, Providence Portland medical CenterFollow
Tracy L. Kelly, Earle A. Chiles Research Institute, Providence Cancer Center, Portland, ORFollow
Susan Mulligan
Patrick Rossi
Ijeoma Uche, Providence St. Joseph Health
Walter Urba, Earle A. Chiles Research Institute, Providence Cancer Center, Portland, OR, 97213, USA.Follow
Alison Conlin, Providence Cancer Center, Portland, Oregon.Follow
Janet Ruzich, Providence St. Joseph HealthFollow
David B Page, Providence Cancer Center, Earle A. Chiles Research Institute Portland , OR , USAFollow

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Publication Date

4-29-2020

Disciplines

Oncology

Abstract

Title:

Manual scalp cooling in early stage breast cancer: value of caretaker training and patient-reported experience to optimize efficacy and patient selection

Authors:

Manaz Rezayee¹, BS Nicole Moxon¹, RN Staci Mellinger¹, RN Amanda Y. Seino¹ Nicole E. Fredrich¹ Tracy L. Kelly¹ Susan Mulligan², MA Patrick Rossi³, MD Ijeoma Uche¹, MD Walter J. Urba¹, MD PHD Alison K. Conlin¹, MD MPH Janet Ruzich¹, DO David B. Page¹, MD

Background:

Alopecia is an emotionally distressing common adverse effect of curative-intent chemotherapy in early stage breast cancer.^1–6 Although machine-based scalp cooling is effective for reduction of chemotherapy-associated alopecia in early stage breast cancer, availability is geographically limited.^7–11 Manual cold-cap systems may also be effective and are available regardless of geographic location.^12–14 We evaluated the feasibility of caretaker-administered cold-cap efficacy following structured standardized training, and utilized patient-reported subjective outcomes to develop a clinical tool to facilitate patient selection.

Patients and Methods:

A small pilot study (n=10) was conducted to evaluate the feasibility and efficacy of manual cold capping. Key eligibility criteria included: 1) no hair loss at baseline; 2) no pre-existing scalp condition; 3) planned curative-intent chemotherapy for early stage breast cancer and 4) availability of caretaker(s). Participants received standardized training and then performed the cold-cap procedure without assistance. The primary endpoint was post-treatment hair retention using Dean’s alopecia scale, with success defined as

Results:

Of the evaluable patients, 80% (n=8/10) met the primary efficacy endpoint (Dean’s scale 0-2) with 20% (n=2/10) trial failures due to pre-mature discontinuation. Manual cold-capping was worthwhile to 90% of patients (Was it Worth It? Questionnaire) and associated with favorable PROs. Patient interviews identified a number of themes shared by almost all patients, which were subsequently used to develop a questionnaire to aid patient-directed decision-making on whether to pursue manual cold-capping.

Conclusion:

This study affirms the safety and efficacy of manual cold-capping to reduce alopecia and demonstrates the importance of proper training and education to maximize efficacy. It also highlights the considerable costs and effort associated with cold-capping. Selected patients with early stage breast cancer may benefit subjectively from cold capping while the proposed clinical instrument can be used to facilitate an informed discussion between patient and provider.

Specialty/Research Institute

Oncology

Specialty/Research Institute

Graduate Medical Education

Specialty/Research Institute

Earle A. Chiles Research Institute

Conference / Event Name

Academic Achievement Day, 2020

Location

Earle A. Chiles Research Institute Fellowship Program