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

Abstract

Background: Chemotherapy-induced alopecia (CIA) is an emotionally distressing aspect of curative-intent chemotherapy for early stage breast cancer. Manual cold-cap systems are universally available to reduce or prevent CIA, but are costly, with outcomes depending heavily on proper technique. We present a pilot case series (n=10) to illustrate the utility of structured caretaker training programs for educating patients on proper technique. We also characterize the subjective patient experience of manual cold capping and propose a clinical instrument, which may be used to discuss the subjective risks and benefits of therapy. Methods: Ten subjects were included in the pilot series, meeting the following eligibility: no pre-existing scalp condition (including no hair loss), chemotherapy for early-stage breast cancer, and caretaker(s) availability. Patients and caretakers underwent standardized training modeled from a community-based training program available in the community. Patient-reported outcomes were characterized using validated instruments and standardized interviews. Results: Following standardized training, 80% (n=8/10) succeeded with manual cold-capping (Penguin™ system), meeting the primary efficacy endpoint of <50% hair loss (Dean's score 0–2 at 30d post-treatment), whereas 20% (n=2/10) discontinued prematurely. Common themes of the subjective effects of cold-capping were identified in interviews, and used to develop a patient-directed questionnaire to facilitate decision-making. Conclusion: This series demonstrates the potential of caretaker training and education in maximizing manual cold-cap efficacy, while also highlighting the considerable costs and effort associated with the intervention. Selected patients may benefit subjectively, and the proposed clinical instrument may be used to guide an informed discussion on the subjective risks and benefits of therapy.

Keywords

• Breast cancer
• Manual cold cap training case report
• Patient experience