Enf.ª Raquel Salgado

Responsible for the Day Care Hospital  

Cryotherapy of the scalp

In the prevention of chemotherapy-induced alopecia

HPA Magazine 20

Alopecia is one of the symptoms that people most associate with chemotherapy treatment. Its frequency is variable and depends on the cytotoxic drug used in the treatment.
According to literature, of all the side effects resulting from chemotherapy, alopecia is the one considered to be the most traumatic, inducing stress and anxiety and having the greatest impact on the patient’s body image and self-esteem. A small percentage of patients even consider refusing chemotherapy treatment to avoid alopecia.

All the physical, emotional, psychosocial changes that the patient goes through, inevitably affects their quality of life and has an impact on the patient’s ability to deal with the entire process of illness and treatment.
Hair is, especially in women, associated with femininity, attractiveness and personality and its loss can often lead to the development of a negative body image, decreased self-esteem and less self-confidence, which can lead to anxiety and depression.
In addition, patients may develop symptoms of depression and anxiety, even before experiencing alopecia, taking into account the beauty standards of the society in which they are inserted. 
Activities that would be simple before, such as outdoor sports or going to the supermarket, become difficult, as patients are afraid of being identified by their illness.
Intervention aimed at minimizing the impact of this adverse effect are necessary and must be developed. Scalp cryotherapy is one of these interventions, already a very common procedure and an integral part of care, in the prevention and/or reduction of chemotherapy-induced alopecia in countries such as the United Kingdom, France, Canada and the Netherlands.
For some, the working mechanism of this procedure depends on two processes, on the one hand, vasoconstriction, which reduces blood flow in the hair follicles and limits the absorption of the cytotoxic drug in the area, and on the other hand, a decrease in the metabolism of the hair follicles, resulting in the follicles being less susceptible to chemotherapy toxicity.
 

Scientific evidence available to date shows us that the effectiveness of scalp cryotherapy depends on several variables, namely the use of an adequate size helmet, the cytotoxic drug used and the person's own characteristics.
Cryotherapy of the scalp, is a safe and tolerable procedure. Although some people mention headaches and feeling cold as undesirable effects. It is possible to overcome these effects with comfort measures, such as the use of a blanket or hot water bottle and taking painkillers. We have therefore been observing changes when providing care to people with oncological disease over time, namely through the acceptance of scalp cryotherapy.
However, changes in clinical practice can be slow, due to the need for accurate and consistent scientific evidence. It is difficult to provide a concrete estimate on the effectiveness of hair preservation for each individual person or treatment, as the number of people with the same type of cancer and receiving the exact same treatment is small. In addition, most studies present a heterogeneous population in terms of gender, age and comorbidities.
Despite the constraints, studies are unanimous in concluding that patients who benefit from the cryotherapy helmet keep a greater amount of hair when compared to those who do not have this possibility.
This knowledge will allow health professionals, and especially nurses in the field of oncology, to debunk myths. 
Nurses are, once again, in a favourable position to transform clinical practice, which directly affects the experience of people with cancer and to promote, above all, their quality of life.
Therefore, and with the aim of improving the care provided, the nursing team at the Day-Care Hospital of the HPA Gambelas have been applying this procedure effectively and with positive results as the path is always aimed towards the well-being and satisfaction of the patient.