Researchers from the North Sydney Mater Hospital conducted the first Australian study of scalp cooling for the prevention of chemotherapy induced alopecia using the Dignitana Dignicap. Women are better able to tolerate the cold as the Dignicap caps gradually cool after application at room temperature and so risk losing less hair, one of the most feared side effects of chemotherapy treatment.
The study was lead by Professor Fran Boyle AM, from the Patricia Ritchie Centre at the Mater Hospital, North Sydney, an advocate of this expensive, but effective, technology. Professor Boyle told oncologynews.com.au “the room temperature cap placement and not needing cap changes help both patients and nurses manage the process.”
Cooling caps induce hypothermia, thought to cause localised vasoconstriction leading to restricted blood flow to the hair follicles, thus protecting them from the full dose of chemotherapy administered. Penguin caps, widely used in the UK and Europe, are pre-cooled silicone caps that have to be regularly changed or caps connected to chair side units that circulate fluid coolant. The North Sydney Mater Hospital have led the use of this technology in Australia since 2010.
Patients who participated in the study of the new Dignicap were being treated for breast cancer with docetaxel/cyclophosphamide chemotherapy. The new caps are applied at room temperature and gradually adjusted 20-30 minutes prior to the administration of chemotherapy, improving comfort as patients acclimatise to the cold. The caps are monitored by sensors that control the temperature, eliminating the need for cap changes. Controls also allow the time to reach treatment temperature to be prolonged or lengthened, depending on patients tolerances.
Nurses in the study observed patients better tolerated the procedure. Of the twenty-six patients involved in the study, only 19% reported the need to use a wig, often one of the most distressing side effects of chemotherapy for women and a barrier to pyscho-sexual adjustment. 50% of patients recorded a Dean’s Alopecia Grade of 2 (25-50% hair loss, with the crown most effected). 53% used a hat and 19% reported they had no need to use head coverings at all.
Other Australian hospitals are keen to embrace the new technology however the unit costs have been prohibitive. At the North Sydney Mater Hospital, donor funding was key to installing the Dignicaps system. Royal Adelaide Hospital are hoping to offer a similar technology soon, the Paxman system. Royal Hobart and Epworth Eastern are also keen to offer the treatment in the New Year and it is hoped other sites will follow suit.
Maxine Morand, CEO of Breast Cancer Network Australia (BCNA), told oncologynews.com.au the “BCNA supports women having the option to use cooling caps to help prevent hair loss and we are supportive of the new technology. It appears to be less severe for the women using them than frozen caps, and easier for oncology nurses to deliver.
“We are aware of only two hospitals which offer women cooling caps however there may be others. Feedback from our members on Penguin cold caps has been very limited. We know of only one BCNA member who has used Penguin cold caps, and she had to hire them privately from the distributor. She was very pleased with the results however.”
Professor Boyle was also able to confirm that the Psycho-oncology Co-operative Research Group (POCOG) have agreed to work with her group on implementation research and a national registry next year. “This will allow us to collect data as we start up new sites and collaborate internationally”. The collaboration will also allow the team to assess results of the treatment on men with prostate and lung cancer.
More data is expected next year as an FDA approved trial being conducted in the US is due to report its findings. Hopes are high that the trial will confirm the greater efficacy of the new technology and help reduce barriers to uptake. Oncologynews.com.au will keep readers posted on these research developments when they are published.