Scalp cooling

A Paxman scalp cooling system includes an inner cooling cap (right) and outer cap cover (left).

Patients undergoing chemotherapy treatment for cancer often can feel like they have lost part of their identity when they begin to notice their hair falling out, as described by two local women.

Hair loss is a common symptom of receiving treatment once a person has been diagnosed with cancer. Debbie Shook, the director of nursing at the Seby B. Jones Regional Cancer Center in Boone, said patients often feel reminded of their cancer each time they look in the mirror and when they go out in public.

“In the midst of being brave and courageous during cancer diagnosis and treatment, losing your hair (because of) chemotherapy becomes very personal and difficult,” said Anne-Corinne Beaver, a general and breast cancer surgeon with the Watauga Surgical Group. “For many patients, it is a breaking point of treatment. While many people are still beautiful, it is hard when losing your hair is not your choice and is a sign of being sick even when you are getting well again.”

To assist patients going through chemotherapy, the Seby B. Jones Regional Cancer Center has obtained technology — called the Paxman Scalp Cooling System — that aims to prevent hair loss caused by certain chemotherapy drugs. The Paxman system is FDA approved and is administered by an inner and outer scalp cap during each chemotherapy treatment, according to the Appalachian Regional Healthcare System.

Paxman technology lowers the temperature of the scalp by a few degrees before, during and after treatment. Beaver said that by cooling the scalp, the blood vessels constrict and therefore decrease the flow of the toxic chemotherapy drugs to the hair follicles, thus preserving more hair follicles. The patient wears a silicone cap, which is then covered by a neoprene cap. This is connected to a cooling machine beside the patient while they sit in a heated chair, Beaver said. Usually, the scalp cooling can last a few hours.

Some hair can still be lost with scalp cooling, but it is considered a success if at least 60 percent of the hair stays; often 75 percent or more remains, Beaver said. The success rate of scalp cooling is dependent on a well-fitted cap, a cold temperature and the type of chemotherapy, according to Shook. Shook said if the cap does not fit the scalp tightly and there are gaps, the result is that hair loss can take place in those gaps.

“The staff at the Seby B. Jones Regional Cancer Center work with patients to help choose the correct size cap, and we encourage patients to practice putting the cap on several times to make sure they are getting a tight fit before receiving their treatment,” Shook said.

To learn more about Paxman Scalp Cooling treatments at the Seby B. Jones Regional Cancer Center, call (828) 262-4332.

How chemotherapy results in hair loss

Typically a person undergoing treatment without the use of scalp cooling may lose hair 14 to 17 days after the first treatment, and it often falls out in “large clumps,” according to Beaver. Shook explained that chemotherapy works by attacking cells that grow rapidly, such as tumor/cancer cells — or hair cells that are also rapidly growing.

“Since chemotherapy drugs are designed to kill rapidly growing cells and cannot differentiate between the good cells and the bad cells, unfortunately hair is lost as it takes the fall along with cancer cells,” Shook said.

Hair usually begins to grow back within one to three months after chemotherapy treatments are completed. Some patients experience a change in the way the hair grows back, and possibly a change in texture or color, Shook said.

Shook added that hair loss is not certain when it comes to receiving chemotherapy as it depends upon the medication and dose prescribed. Some chemotherapy drugs can cause hair loss, others may not. Beaver added that the likelihood of hair loss with most chemotherapy drugs is 100 percent, while hair could be kept with some of the targeted new chemotherapy drugs that act only on cancer cells. Beaver added that one of the chemotherapy drugs even has an 11 percent risk of permanent hair loss.

Just before Christmas in 2017, Beaver received a pathology report that confirmed that she had breast cancer and would need chemotherapy. To prepare for hair loss she bought some wigs, but her family convinced her to try scalp cooling. With some skepticism, Beaver decided to give it a try.

“I thought that I could be the person to try it out to see if it really worked and was worth the freezing and expense,” she said.

Beaver would sit for five hours of scalp cooling at a time, and would be cold but surrounded by “blankets, prayers and warm tea” from family members. She said she kept over 75 percent of her hair.

“I was amazed because I still felt like me,” Beaver said. “The unexpected outcome was not how I looked, but that this did not allow cancer to define me. It allowed me to return to my life and the things I loved, leaving the marks of cancer behind. This was an incredible and unforeseen boost.”

Scalp cooling technology

Scalp cooling technology was employed in Europe for years, but has only within the last few years received FDA approval in the U.S. for both breast cancer and other solid tumor cancers, Beaver said. It is not appropriate for any cancers which might metastasize to the scalp, such as melanoma. There are two companies in the world providing continuous scalp cooling; Paxman is the company that the Seby B. Jones Cancer Center chose to use.

Beaver said Paxman has a vision to make scalp cooling available for everyone who desires to use it, and charges a lower price in order to make it more affordable. The Paxman business was founded by Glenn Paxman, after he and other families members watched his wife lose her hair due to chemotherapy for breast cancer, according to the organization.

Shook said the Appalachian Regional Healthcare Foundation provided funding for the Paxman equipment from donations raised through a Giving Tuesday campaign in November 2018. The Seby B. Jones Regional Cancer Center is the only Paxman Scalp Cooling provider within a 250-mile radius, according to ARHS.

Beaver said she approached ARHS about the scalp cooling, and it became a reality in April of this year. Since obtaining the Paxman Scalp Cooling system, the cancer center has treated one patient, Shook said.

“It is exciting to be one of the first places in our entire Southeast region to have this technology for patients, and it shows the vision and compassion of our Seby B. Jones Cancer Center,” Beaver said.

Paxman gives a few cost examples for what Paxman scalp cooling services could be for eight chemotherapy treatments or 12 chemotherapy treatments. The eight chemotherapy treatment example listed the price at $500 for the cap kit and around $1,300 for the service for all of the eight cycles — totaling to $1,800. The chemotherapy cycle of 12 treatments listed the $500 for the cap kit and $1,700 for services during the 12 treatments — for a total of $2,200. Paxman states that pricing per patient is capped at $2,200.

Beaver said the Seby B. Jones Cancer Center does not bill the patient for scalp cooling; the patient’s expenses are with Paxman Scalp Cooling System. For more information on treatment pricing, visit www.paxmanusa.com/patients/pricing.

Both Beaver and Shook said that scalp cooling therapy is not typically covered by health insurance plans. While Paxman does provide a form to send to insurance companies requesting coverage, “as this is now considered part of treatment,” most insurance companies do not cover it, Beaver said.

Shook said the National Comprehensive Cancer Network recently updated the Clinical Practice Guidelines in oncology for breast cancer to include scalp cooling as a Category 2A recommendation to reduce the incidence of chemotherapy-induced alopecia for patients.

“With this recommendation now in the Clinical Practice Guidelines, we are hopeful that insurances will soon begin to provide coverage for scalp cooling treatment,” Shook said.

Patient assistance for scalp cooling may be available for some through the organization Hair to Stay — a nonprofit that states it has provided more than 1,400 subsidies for scalp cooling to date. For more information, visit www.hairtostay.org.

Beaver said the High Country Breast Cancer Foundation has a special fund to help with patient costs, and would appreciate donations to help chemotherapy patients pay for scalp cooling. More information on the High Country Breast Cancer Foundation can be found at highcountrybreastcancerfoundation.org.

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