For patients with cancer, body image issues related to chemotherapy-induced hair loss can add to the stress of coping with their illness. To address this concern and help patients maintain their hair during chemotherapy, Lehigh Valley Health Network's Cancer Institute implemented a scalp cooling program. In this interview with i3 Health, Kerry Kluska, RN, MSN, OCN®, who served as a nurse and patient educator during the scalp cooling implementation, discusses the process involved in instituting this program.
What are the benefits of scalp cooling for oncology patients?
Kerry Kluska, RN, MSN, OCN®: Using scalp cooling to preserve hair follicles while receiving alopecia-causing chemotherapy is a personal choice. If I had to give a benefit, it is the potential to preserve your hair follicles and maintain up to 50% of your hair while going through treatment. Preservation of hair follicles and faster hair regrowth have been seen in those who have used scalp cooling.
What did it take to implement this program?
Ms. Kluska: It took coordination and education of all of the infusion staff, providers, and nurses in the office, and it took buy-in from the administration.
What is the procedure for scalp cooling?
Ms. Kluska: A cap fitting is completed in the office. The patient makes the decision whether or not to follow through. Paperwork is completed and sent if the patient decides to use scalp cooling. The cap is sent to the patient's home. The patient is expected to practice at least three times, dampening their hair, applying the conditioner used during cooling, placing the headband on their forehead to protect their skin, and applying both the inner and outer cap on their head. The patient is also expected to watch the videos for applying the cap prior to their first treatment.
Upon arrival to the infusion center, the patient puts the cap on. The nurse can assist the patient if needed; however, accountability is placed on the patient to place their cap on their head. The nurse will attach the cap to the cooling machine, turn on the machine, and set the times on the machine.
How did the nurses involved in implementing this program feel about the experience?
Ms. Kluska: Initially, the nurses were nervous about implementation; they struggled with the idea of doing one more thing during treatment. As one of the educators, during implementation and up to almost the first year, I made myself readily available for all new patients using scalp cooling and assisted the nurses and patients with the application of the cap and starting the cooling machine. I walked the nurses through the process to alleviate the nurses' anxiety about the cap.
Were there any adjustments that had to be made following initial implementation?
Ms. Kluska: There were not adjustments per se. We did a follow-up re-education several months after the program's initiation by bringing back the scalp cooling company representative and allowing the nurses to ask questions independently and not in large groups. We reviewed the setting up of the machine, the time on the machine, and how to trouble shoot should anything go wrong or appear not to be functioning correctly. Also, it worked better in the end to have a core group of nurses to do the scalp cooling instead of having all nurses trying to learn how to do this procedure.
What advice can you give to oncology nurses whose hospitals are considering starting a scalp cooling program or to nurses who would like to suggest that their hospital start such a program?
Ms. Kluska: I would ask, do you have patients asking for such a program? Have patients left their network to go somewhere else that offers scalp cooling? My other piece of advice is do not judge your patient for wanting to keep their hair. Battling cancer is emotional enough. It is up to the nurse to support the patient in this decision. We as nurses may not understand the strong desire to maintain hair, but it is up to us to be there for our patients and support their needs.
About Ms. Kluska
Kerry Kluska, RN, MSN, OCN®, is an Oncology Clinical Nurse Specialist at Lehigh Valley Health Network's Cancer Institute in Allentown, Pennsylvania.
Transcript edited for clarity. Any views expressed above are the speaker's own and do not necessarily represent the views of i3 Health.