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Cancer affects every aspect of an individual’s life including their physical, emotional, and spiritual wellbeing. Needless to say, one’s physical appearance plays a pivotal role in influencing their self-esteem and confidence. For several decades, cooling caps have been implemented to reduce hair loss for patients who are undergoing chemotherapy. This evolving current innovation has gained widespread popularity since its inception decades ago. However, it is important to note the purpose of a cooling cap, its advantages and disadvantages, as well as incorporating it into today’s practice.

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'Cold Cap' May Help Patients Undergoing Chemo Keep Their Hair

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Chemotherapy-induced alopecia, or CIA, can be treated by means of cooling caps “using either cold caps, which consist of shower cap-like head coverings that require chilling/freezing and frequent changes throughout therapy to maintain scalp hypothermia, or automatic, machine-based cooling systems, which consist of a tightly fitted cap connected to a device that circulates coolant through the cap and thus gradually cools the scalp to maintain a set temperature throughout treatment” (Kruse and Abraham, 2018).

Cooling caps reduce CIA by causing the following:

· “The cold temperature induces vasoconstriction and therefore limits the cellular uptake of cytotoxic agents

· The cold temperature reduces metabolic activity and therefore decreases the effect of chemotherapy on follicular cells” (Young and Arif, 2016).

By causing vasoconstriction, cooling caps reduce the side effect of hair loss that chemotherapy so often causes.

Figure 1. An example of a cooling cap. Taken from Young, A., & Arif, A. (2016). The use of scalp cooling for chemotherapy-induced hair loss. British Journal of Nursing, 25(10), p. S24.

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An overview of a Cooling Caps company for the U.S. market.

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· Hair growth began for some patients approximately three to six weeks after their chemotherapy ended (van den Hurk et al., 2013).

· Cooling caps improve one’s self-esteem while they are undergoing chemotherapy as it reduces hair loss. Physical appearance is of particular importance to women.

· “Because prevention of chemotherapy-induced alopecia may have an effect on the quality of life and psychosocial well-being, use of scalp-cooling technology should be viewed as a means to care for the whole patient rather than a solely cosmetic issue” (Kruse and Abraham, 2018).

· Since patients already feel like they are losing their sense of control over the situation, having their hair intact enables them to feel as if they can mask their vulnerability in front of society. This aspect gives them a sense of control over their lives.

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· According to Komen, Smorenburg, van den Hurk, and Nortier (2013), “the thickness of the hair layer correlated with the scalp skin temperature during scalp cooling. This may explain the lower effectiveness of scalp cooling in patients with black African hair, who have a thick layer of hair that acts as an insulating layer between the cooling cap and the scalp” (p. 886).

· “Another US research team has recently stated that despite scalp cooling, most participants report hair thinning [which can be seen as a failure to some patients] and this is indicative that chemotherapy still penetrates the scalp” (Young and Arif, 2016). Therefore, although scalp cooling is intended to minimize hair loss, it can consequently cause hair thinning.

· “The occurrence and severity of CIA is dependent on the chemotherapeutic dose, administration schedule and other protocols” (Shin, Jo, Kim, Kwon, and Myung, 2014). As a result, the chemotherapeutic regimen that is administered will play a crucial role in the success of using the cooling cap.

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· The caps can also cause one’s original hair color to change, in some cases.

· “The most often reported side effects of scalp cooling include headaches, complaints of coldness and/or uncomfortable sensations, and claustrophobia. Scalp cooling is contraindicated for patients with cold sensitivity, cold agglutinin disease, cryoglobulinemia, cryofibrinogenemia, and post-traumatic cold dystrophy” (Komen et al., 2013).

· Side effects can also include nuchal rigidity and hypothermia, which can cause shivering and discomfort.

More importantly, cooling caps can mask the side effects of chemotherapy as it will be unclear whether a patient is having a reaction to the chemotherapeutic agent(s) itself or the cooling cap.

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Moreover, it is extremely important to evaluate this innovation, so that it can possibly be adopted within my practice. As a nurse working in the oncology setting, I have chosen Alice, Angelica, Carter, Louis, and Pablo to join me as we evaluate the feasibility of cooling caps. Alice is an achiever and she enjoys executing a plan as much as I do. Her strong work ethic and “Never Give Up” attitude will play a crucial role in leading our team. Angelica is analytical, so her strategic thinking will be useful in seeing all sides of this innovation such as effectiveness, feasibility, and patient satisfaction. I believe that she will gather everyone’s opinion(s) before carefully making a prudent decision. Angelica will also be able to determine if cooling caps are cost-effective or actually end up costing our practice a substantial amount of money.

Carter is remarkable at communicating his thoughts so as to influence others’ opinions.

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His communication skills will be beneficial when pitching the idea of cooling caps to upper management. I believe that he will be able to influence and engage the practice administrators into seeing the usefulness of cooling caps and the simple fact that it will certainly help our patients that are receiving chemotherapy. I am a learner just like Louis, so he will be a vital asset to our team, because he will want to learn all about cooling caps including the mechanism of action and its benefits. Both of us are concerned with learning about this innovation thoroughly rather than anything else. Lastly, to join our team, Pablo will be a great addition, because he is extremely positive and only sees the “good” in every situation. He will be instrumental in building and maintaining our team’s relationship. His infectious attitude will be helpful when things get stressful and disagreements ensue. By choosing Alice, Angelica, Carter, Louis, and Pablo, I believe that we will have a strong team that will be able to convince the administration about the advantages of providing cooling caps for our patients.

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Therefore, cooling caps are a great resource for patients who must undergo chemotherapy and want to minimize their hair loss. I have personally cared for patients, specifically women, who become depressed that they are experiencing hair loss and I know that some facilities are strictly against the use of cooling caps. For many patients, a strong physical appearance is essential as it prevents others from realizing that the patient actually has cancer. A full head of hair gives patients confidence and a high level of self-esteem. As mentioned previously, numerous factors account for the success and sometimes failure of cooling caps such as the chemotherapeutic agents that are administered, the thickness of one’s hair prior to receiving chemotherapy, and the medication dose that is given, among others. I certainly feel that much more research needs to occur on this topic as most of it involves only breast cancer patients at this time. Also, it is important to determine how the cost of cooling caps can be reduced, so that it can be more feasible in various healthcare settings.

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In conclusion, cooling caps offer numerous benefits to patients such as improving their emotional wellbeing. Although more research needs to be conducted on this innovation, the intent of cooling caps is to preserve hair follicles for patients undergoing chemotherapy. The caps can be thought of as an alternative to wearing a wig or a head cover as it is the patient’s own hair that grows back after chemotherapy has been completed. Facilities need to incorporate this valuable resource to aid caring for patients in a holistic manner. Through the use of cooling caps, patients can take advantage of all the benefits that they have to offer in addition to becoming more feasible, so that numerous individuals can also have access to this current innovation.

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Komen, M. M.C., Smorenburg, C. H., van den Hurk, C. J.G., & Nortier, J. W.R. (2013). Factors influencing the effectiveness of scalp cooling in the prevention of chemotherapy-induced alopecia. The Oncologist, 885-891. http://dx.doi.org/10.1634/theoncologist.2012-0332

Kruse, M., & Abraham, J. (2018). Management of chemotherapy-induced alopecia with scalp cooling. American Society of Clinical Oncology, 14. 149-154. https://doi.org/10.1200/JOP.17.00038

Shin, H., Jo, S. J., Kim, D. H., Kwon, O., & Myung, S.-K. (2014). Efficacy of interventions for prevention of chemotherapy-induced alopecia: A systematic review and meta-analysis. International Journal of Cancer, 136. E442-E454. doi:10.1002/ijc.29115

van den Hurk, C.J.G., van den Akker-van Marle, M.E., Breed, W.P.M., van de Poll-Franse, L.V., Nortier, J.W.R., & Coebergh, J.W.W. (2013). Impact of scalp cooling on chemotherapy-induced alopecia, wig use and hair growth of patients with cancer.European Journal of Oncology Nursing, 1-5. http://dx.doi.org/10.1016/j.ejon.2013.02.004

Young, A., & Arif, A. (2016). The use of scalp cooling for chemotherapy-induced hair loss. British Journal of Nursing, 25(10), S22-S27.

Youtube. (2015). 'Cold Cap' may help patients undergoing chemo keep their hair[Video]. Available fromhttps://youtu.be/EWne0ZP1D3U

Youtube. (2018). Paxman Scalp Cooling - US Overview [Video]. Available fromhttps://youtu.be/Kbjw7SLKWk4