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My name is Pamela Fitzpatrick and I have worked in the chemotherapy day area at Ninewells Hospital, Dundee for approximately 13 years. I originally started as a Health Care Assistant and through time was promoted to Healthcare Support Worker. My role is extremely varied and includes working clinically with cancer patients, which is my absolute passion. I keep my knowledge and skills up-to-date regularly and have attended various study days and courses relevant to oncology. I have also completed my SVQ 3 modules and attended a short course in palliative care.

My background, prior to nursing was a hairdresser. This has provided the perfect foundation to understanding the importance of hair and body image. It also means I have an acute awareness of the fear and distress hair loss and the thought of hair loss causes our patients. For some patients, hair loss is their biggest fear over and above other side effects of chemotherapy. I feel very strongly that, where possible, all patients who are at risk of hair loss through chemotherapy, should be offered the chance to retain it. From my experience, a large proportion of our patients welcome the chance to retain it too.

Patients’ level of awareness of scalp cooling varies. Some patients have done their own research prior to attending the chemotherapy day area and are fully informed about scalp cooling. The first question they often ask is “Do you have a scalp cooling machine?” and “Can I use it?”. Some patients are completely unaware and others have been informed of scalp cooling by consultants and nurses in the clinic prior to attending for their first chemotherapy. Others may have been informed of it at the Maggie’s Centre. Our experience shows that some consultants are more reluctant than others to offer scalp cooling.

Our unit has been offering scalp cooling for more than 18 years. Over the years there have been great improvements in the technology of the machines and more research which has led to an improved patient experience and an increase in its use. Myself and colleagues all feel it is extremely important that patients are provided with scalp cooling information and are able to make an informed choice whether they want to use it or not.

My role involves explaining what scalp cooling involves when patients attend for their pre-course assessment prior to their first chemotherapy, providing the Paxman information leaflet and measuring them for the correct size of cap. I also answer any questions or queries the patients may have. At this visit I recommend patients layer up with cosy clothes on the day of treatment and take paracetamol an hour before using the machine.

I advise patients to take extra care with their hair and be extremely gentle with no vigorous towel drying, no hair straighteners and no pulling on their hair with brushes. I also recommend patients don’t colour their hair and don’t use dry shampoo or baby shampoo. The products I recommend are simple, organic or Paxman shampoo. In the event that the cold cap is not successful, I always advise patients to prepare for this and get organised with a wig just in case.

On the day of treatment, my role involves putting patients onto the Paxman Scalp Cooling machine. I wet and condition their hair first, place a head band over the forehead and ears, then place the cold cap snug but comfortably on their head and set the machine to the correct time. Patient comfort is ensured throughout their treatment and time on the machine, by providing blankets and tea/coffee.

Additionally, I train staff in the use of the machines and measuring for the correct size of cap. I also carry out regular essential maintenance to ensure the machines remain in good working order.

Carrying out scalp cooling as part of my role means I see all patients who are using the machine every time they attend and can monitor closely the response they have. It also means I have the opportunity to provide consistency and continuity of care to my patients which is invaluable to them and is the part of my job that I love most.

From my experience, patients tolerate the cold cap reasonably well and the results are mostly very successful. There is the very rare occasion when patients are unable to tolerate it and it does not work for them. Some patients will experience hair thinning whilst using the cold cap, however, this is acceptable to them because it means they can still present themselves as visually ‘normal’ in their everyday lives.

Retaining hair through the use of the cool cap has huge benefits for patients. My patients tell me that they “do it for their children”, “to get them through treatment” and most importantly they don’t have to tell everyone they have cancer and are undergoing chemotherapy. Being able to retain their hair means their body image is preserved and they can retain some sense of normality. Essentially, it goes a long way in helping them cope with their treatment.

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Pam, Healthcare Support Worker, Ninewells Hospital Dundee
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