The Importance of the Nursing Role in Scalp Cooling and Chemotherapy Side effect Management

Conversation led by Dr Erica Fischer-Cartlidge with Josephine Divers, Ruth Hammond, Lauren Matthews, Elisa Mills and Julianna Paulucci, on the importance of the nursing role in scalp cooling. April 2022.

While physicians are often considered to be the gate keepers of scalp cooling, nursing teams are the ones on the front-line delivering scalp cooling to patients. The impact nurses have on a patient’s experience of their treatment is substantial and not to be underestimated. From making a patient as comfortable as possible on the day of chemotherapy, through to the delivery of workflows to ensure the best possible scalp cooling outcomes, not to mention making patients feeling supported and cared for.

"The patient will always lean on the nurse, the nurse will always be the advocate. If it was left between consultant and patient, I don’t believe the uptake would be as big as it is. The nurses are the advocate, and take away the fear factor"

Ruth Hammond
  • The close relationships that develop between nurse and patient are fundamental to ensuring trust, support, guidance and that informed decision making is possible – nurses are the original patient advocates
  • Up to date knowledge of scalp cooling literature and data are key to being able to adapt processes and deliver the best care
  • Patients are informed consumers of healthcare and it is important that clinical teams continuously seek the latest data

‘The patient will always lean on the nurse, the nurse will always be the advocate. If it was left between consultant and patient, I don’t believe the uptake would be as big as it is. The nurses are the advocate and take away the fear factor’ – Ruth Hammond

Scalp cooling is a shared experience between the patient and clinical staff, particularly nurses, who are the ones who deliver the treatment. Time spent with the patient and the close bonds that are often forged, help to engender a relationship of implicit trust between patient and nurse. It is therefore incredibly important that nursing teams provide balanced views, are educated on current data, and are learning from experience in order to allow patients to make informed decisions about whether scalp cooling is right for them.

‘There’s a huge variety in outcomes as recorded in published data – so it’s all about helping a patient identify on that broad spectrum what they can anticipate’ – Mikel Ross 

Time is one of the most valuable resources that a nurse can give a patient – to manage their expectations, explain processes, listen to their concerns, allay their fears, and boost their confidence, ensuring that scalp cooling workflows/protocols are adhered to. Workflows were born from research and data, and success relies upon strict adherence. It is also important to remember that patients often observe a nurses’ actions both with themselves and other patients – so consistency is key.

‘There’s a reason that nurses continue to be the most trusted profession year after year’ – Dr Erica Fischer-Cartlidge

One of the biggest hurdles for nursing teams is the misconception that scalp cooling doesn’t work and the resulting lack of support that can stem from this belief. A combination of data and patient testimonials can be a good way of tackling these attitudes, as well as networking with peers who are using scalp cooling successfully. Scheduling can also be a challenge in busy infusion units, but not insurmountable. 

‘The APP’s and nurses have to reassure them that shedding is normal, it is going to happen – it’s a constant reinforcement at every stage, and having to know that at every stage your staff know how to handle it’ – Josephine Divers

Managing a patient’s expectations can make or break their experience of scalp cooling. This responsibility includes a spectrum of actions, from ensuring they know what scalp cooling entails (e.g. cap fitting, hair preparation etc.), preparing them for the challenging first 15 minutes, that shedding is a normal part of the process, and advising on realistic hair retention rates based on their regimen. It should not be underestimated how this level of nursing guidance and support can provide a patient peace of mind and confidence.   

Nursing staff are with a patient from the very beginning to the very end of chemotherapy. The relationships that are built are key to ensuring the best possible patient care and the most successful scalp cooling treatment. Taking the time to educate and empower patients to make positive decisions about their own care, and to keep up to date with current data and literature, will ensure that nurses can continue to be exceptional advocates for their patients.

Peterson LL, et al. Integration of Physician and Nursing Professional Efforts to Deliver Supportive Scalp Cooling Care to Oncology Patients at Risk for Alopecia. Oncol Ther. 2020 Dec;8(2):325-332.

Fischer-Cartlidge E, et al. Scalp Cooling: Implementation of a Program at a Multisite Organization. Clin J Oncol Nurs. 2018 Oct 1;22(5):534-541.

Mulders M, et al. The impact of cancer and chemotherapy: perceptual similarities and differences between cancer patients, nurses and physicians. Eur J Oncol Nurs. 2008 Apr;12(2):97-102.