Changing the Face of Cancer: Recent Episodes
Paxman Scalp Cooling
Chemotherapy is a powerful cancer treatment, but its side effects have a real impact on a patient’s physical and mental wellbeing – so how is oncology care tackling these debilitating effects?
Our host Richard Paxman sits down with renowned oncologists, clinical researchers and medical thought leaders, to discuss the development and practice of side effect management, such as scalp cooling, and challenging healthcare preconceptions.
This podcast will investigate how cancer treatment pathways can focus on patient-centric care, the barriers faced, and the steps the global oncology space are taking to integrate cryotherapy to improve quality of care for patients.
"We need more peer to peer sharing through conferences and grand rounds. We need to look at research into increasing efficacy in under-served populations, different head shapes, and anthracyclines."
Richard Paxman sits down with oncology thought leaders and renowned clinical trial experts, to review scalp cooling trial data and results from the past decade, and consider what needs to be looked at next to improve efficacy within under-served populations.
The group argue that scalp cooling tolerability and efficacy is well established and now is the time to look at more specific determinants of outcome, and push for individuals to identify the gaps that need to be addressed and carry out the trials to address them.
Bullet points:
- Many areas require further investigation to ensure that scalp cooling can be proven to be effective for more diverse populations, and protocols can be optimized to ensure the findings can be put into practice in clinic
- Lab based research to understand chemotherapy and the impact of scalp cooling at a cellular level is the key to unlocking more efficacious treatment, especially in treatment scenarios which are more challenging
Shownotes:
- Visit The Scalp Cooling Study Library.
- Nangia J, et al. Effect of a Scalp Cooling Device on Alopecia in Women Undergoing Chemotherapy for Breast Cancer: The SCALP Randomized Clinical Trial. JAMA. 2017 Feb 14;317(6):596-605.
- Dunnill C, et al. Cooling-mediated protection from chemotherapy drug-induced cytotoxicity in human keratinocytes by inhibition of cellular drug uptake. PLoS One. 2020 Oct 15;15(10):e0240454.
- Bajpai J, et al. “Randomised controlled trial of scalp cooling for the prevention of chemotherapy induced alopecia”. Breast. 2020 Feb;49:187-193.
- Dilawari A, et al. Does Scalp Cooling Have the Same Efficacy in Black Patients Receiving Chemotherapy for Breast Cancer? Oncologist. 2021 Apr;26(4):292-e548.
- Araoye EF, Stearns V, Aguh C. Considerations for the Use of Scalp Cooling Devices in Black Patients. J Clin Oncol. 2020 Oct 20;38(30):3575-3576.
- Ohsumi S, et al. Prospective study of hair recovery after (neo)adjuvant chemotherapy with scalp cooling in Japanese breast cancer patients. Support Care Cancer. 2021 Oct;29(10):6119-6125.
- Information on the International Chill Registry.
"Always offer, it is up to patient to figure out whether or not they can afford something, and not up to us to assume whether they can afford something"
Diversity and equity are currently high on the healthcare agenda - however there are still noticeable inconsistencies when it comes to side effect management in cancer care. Maimah Karmo, Founder of Tigerlily Foundation, sits down with oncologists and patient advocates to discuss why having appropriate individualized care is incredibly important for minority populations, with many chemotherapy side effects centred on skin toxicities and hair loss. They ask the questions – are patients of color receiving the same standard of cancer care as Caucasian patients? And what needs to be done to ensure that all patients are provided with equitable and accessible tailored supportive care?
Bullet points:
- Equitable side effect management options, including scalp cooling, should be a viable choice for patients of color undergoing chemotherapy
- The lack of clinical research that focuses on patients of color is problematic, particularly as there are doubts around the efficacy of scalp cooling for patients with type 3 & 4 hair, despite positive anecdotal patient experiences
- A lack of appropriate hair care support and guidance from clinicians stems from a lack of education, placing an unnecessary burden onto the patient as a result
- Bias around financial capability means that patients of color are not being offered scalp cooling
Shownotes:
- Tigerlily Foundation Clinical Trial Program
- Scalp Cooling for Chemotherapy-Induced Alopecia in Patients of Color: A Clinical and Mechanistic Study
- Dilawari A, et al. Does Scalp Cooling Have the Same Efficacy in Black Patients Receiving Chemotherapy for Breast Cancer? Oncologist. 2021 Apr;26(4):292-e548.
- Araoye EF, Stearns V, Aguh C. Considerations for the Use of Scalp Cooling Devices in Black Patients. J Clin Oncol. 2020 Oct 20;38(30):3575-3576.
"We talk to our patients a lot about being self-empowered – this is your opportunity to really self-manage this and take some responsibility in terms of the outcome."
Dr Lindsay Peterson sits down with a multidisciplinary group of physicians, to discuss the wider picture surrounding protocols within chemotherapy side-effect management. They consider the often challenging integration of practices such as scalp cooling, and discuss their tried and tested approaches, detailed workflows, and the importance of interdisciplinary buy-in within their medical institutions, which has had a real impact on outcomes – and simultaneously empowered their patients as a result.
Shownotes:
- 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.
- Komen MM, et al. Results of 20- versus 45-min post-infusion scalp cooling time in the prevention of docetaxel-induced alopecia. Support Care Cancer. 2016 Jun;24(6):2735-41.
- van den Hurk CJ, et al. Learning from best scalp cooling practices in a registry: Differences in results from n>7000 patients with solid tumors. Journal of Clinical Oncology 2019 37:15_suppl, 11610-11610.
- Rugo HS, et al. Association Between Use of a Scalp Cooling Device and Alopecia After Chemotherapy for Breast Cancer. JAMA. 2017;317(6):606–614.
- van den Hurk CJ, et al. Short post-infusion scalp cooling time in the prevention of docetaxel-induced alopecia. Support Care Cancer. 2012 Dec;20(12):3255-60.
- van den Hurk, et al. (pre-)Clinical research to understand alopecia and improve cooling results. Netherlands Comprehensive Cancer Organisation, 2015.
- Information on the International Chill Registry.
"Just about every single patient entering a cancer center who is likely to undergo treatment is a potential patient where an onco-dermatologist has a role"
Dr Nicole LeBoeuf, Dr Beth McLellan, and Dr Ian Tattersall, have all chosen to specialise in the skin toxicity side effects of patient’s undergoing cancer treatment. In a discussion led by Dr Corina van den Hurk, they talk about being embedded within their respective oncology units, the side effects they witness daily affecting the skin, hair, and nails of patients receiving chemotherapy and radiation therapy, and the lasting impact this can have on quality of life.
With patients often referred to their services once treatment has finished, they explain why dermatological interventions can be significantly more effective if they are positioned as a preventative measure in the treatment timeline, as opposed to a curative measure at the end.
Shownotes:
- Lacouture ME, et al. Prevention and management of dermatological toxicities related to anticancer agents: ESMO Clinical Practice Guidelines. Ann Oncol. 2021 Feb;32(2):157-170.
- Lacouture ME, et al. Clinical practice guidelines for the prevention and treatment of EGFR inhibitor-associated dermatologic toxicities. Support Care Cancer. 2011 Aug;19(8):1079-95.
"Increased hair regrowth rates really was our pitch to help some of our oncologists who were less optimistic about scalp cooling with anthracyclines."
Oncologist Dr Julie Nangia sits down with oncology thought leaders from Japan, Germany, and South Korea, to discuss what unites their cancer care practice – prescribing scalp cooling for patients on anthracycline regimens.
Despite hair retention with scalp cooling on anthracycline regimens generally being lower in comparison to taxanes, the group discuss why having a ‘taxanes only’ mentality is limiting patient choice. They argue that ‘successful’ hair retention is subjective, and rates that might be seen as a failure by a physician may be seen as successful by a patient. They also discuss the faster hair regrowth benefits of scalp cooling, the longer-term effects of which can motivate patients to continue with scalp cooling even if significant hair loss is sustained, helping patients move on from treatment faster.
Shownotes:
Kinoshita T, et al. Efficacy of Scalp Cooling in Preventing and Recovering From Chemotherapy-Induced Alopecia in Breast Cancer Patients: The HOPE Study. Front Oncol. 2019 Aug 6;9:733.
Ohsumi S, et al. Scalp cooling for hair loss prevention in female Japanese breast cancer patients receiving (neo)adjuvant chemotherapy. Support Care Cancer. 2021 Jan;29(1):437-443.
van den Hurk CJ, et al. Scalp cooling for hair preservation and associated characteristics in 1411 chemotherapy patients – results of the Dutch Scalp Cooling Registry. Acta Oncol. 2012 Apr;51(4):497-504.
Rice BA, et al. Registry study to assess hair loss prevention with the Penguin Cold Cap in breast cancer patients receiving chemotherapy. Breast Cancer Res Treat. 2018 Jan;167(1):117-122.
"In using cryocompression to prevent CIPN, we have several advantages in terms that there is a huge need being driven by the patients themselves, and we have the physicians who are open to adopting newer technologies and try them out in clinical trials than there were a few years ago."
Chemotherapy-induced peripheral neuropathy is an unseen, but lifelong and potentially debilitating chemotherapy side effect. With very few treatment interventions, prevention and reversal of CIPN has been largely unsuccessful to this point. Clinicians have witnessed patients using off the shelf cryotherapy options, but they are unmeasured, untested, and often ineffective.
Dr Charles Loprizini sits down with oncologists and researchers to discuss what we already know about CIPN’ its impact on physical and psychological quality of life, and why the development of a new cryocompression device is showing real promise in preventing the condition as the next stage of trials begins.
Shownotes:
- Loprinzi C, et al. Prevention and Management of Chemotherapy-Induced Peripheral Neuropathy in Survivors of Adult Cancers: ASCO Guideline Update. Journal of Clinical Oncology 2020 38:28, 3325-3348
- Jordan B, et al. Systemic anticancer therapy-induced peripheral and central neurotoxicity: ESMO-EONS-EANO Clinical Practice Guidelines for diagnosis, prevention, treatment and follow-up. Ann Oncol. 2020 Oct;31(10):1306-1319.
- Kanbayashi Y, et al. Comparison of the efficacy of cryotherapy and compression therapy for preventing nanoparticle albumin-bound paclitaxel-induced peripheral neuropathy: A prospective self-controlled trial. Breast. 2020 Feb;49:219-224.
- Shigematsu H, et al. Cryotherapy for the prevention of weekly paclitaxel-induced peripheral adverse events in breast cancer patients. Support Care Cancer. 2020 Oct;28(10):5005-5011.
- Schmid P et al. Pembrolizumab for Early Triple-Negative Breast Cancer. N Engl J Med 2020; 382:810-821.
- Filter by ‘Chemotherapy Side Effect’ on the Scalp Cooling Studies Website for more clinical studies on the use of cryotherapy for CIPN: www.scalpcoolingstudies.com
"The changes are so rapid and so quick. The mental effects of hair loss is huge – the passion and the empathy from our clinicians is imperative."
Professor Catherine Paterson sits down with Dr Amy Comander, RN Trisha Marsolini, Dr Eleonora Teplisnky, and patient advocate Asha Miller, to discuss why cancer treatment is not only physically challenging, but how the psychosocial side-effects of chemotherapy can send tidal waves through a patient’s life for many years.
They discuss their own holistic approaches to patient-centred care, Maricia recounts where she felt the support was missing within her own treatment, and the moments in which she believed her overall wellbeing was being appropriately treated, not just the cancer.
Shownotes:
- Paterson C, et al. Identifying the supportive care needs of men and women affected by chemotherapy-induced alopecia? A systematic review. J Cancer Surviv. 2021 Feb;15(1):14-28.
- Lemieux J, et al. Chemotherapy-induced alopecia and effects on quality of life among women with breast cancer: a literature review. Psychooncology. 2008 Apr;17(4):317-28.
- Rosman S. Cancer and stigma: experience of patients with chemotherapy-induced alopecia. Patient Educ Couns. 2004 Mar;52(3):333-9.
- van den Hurk CJ, et al. Impact of alopecia and scalp cooling on the well-being of breast cancer patients. Psychooncology. 2010 Jul;19(7):701-9.
- Choi EK, et al. Impact of chemotherapy-induced alopecia distress on body image, psychosocial well-being, and depression in breast cancer patients. Psychooncology. 2014 Oct;23(10):1103-10.
For Season 2 of the podcast, you can hear some of the best bits from our Summit Series. Launches 29th March 2023.
For more visit https://scalpcoolingsummit.com/
In this episode, Rich sits down with Elahe Salehi, who is involved in the ground-breaking clinical trial currently being carried out at the Dana Farber Cancer Institute, comparing hair retention rates with scalp cooling in the metastatic setting. The chemotherapy drug regimens in question are Sacituzumab govitecan, Eribulin, and the highly anticipated Trastuzumab deruxtecan, also known as Enhertu. They discuss the motivations behind the trial and its design, and the outcome measures decided upon which look closely at the impact on patient quality of life. They also ask, why is it that previously little has been done in the metastatic setting with scalp cooling, and that just because the majority of scalp cooling research has been carried out with early stage solid tumors, this is not a valid reason to not offer to metastatic patients.
In this bonus episode, Corina van den Hurk of the Netherlands Comprehensive Cancer Organisation discusses the expansion of the Dutch Scalp Cooling Registry to include international data, following the success of the database of over 7,000 Dutch patients scalp cooling results, which has provided a vital insight into scalp cooling efficacy. Maryam Lustberg, Chief of Breast at Yale Cancer Centre, also expresses her support for the registry, as it continues to drive the movement towards precision symptom management within cancer care.
As well as providing an insight on how Corina and her team are increasing their analysis of the registry to measure further variables, they also discuss the gaps in scalp cooling clinical research and what the future holds for collecting this all important data. Listen to find out how you can be a part of the International Scalp Cooling Registry, and help shape this database to better educate and inform both clinicians and patients in the future.
In this episode, Rich is joined by Dr Raghav Sundar and Dr Aishwarya Bandla from the National University Cancer Institute in Singapore. They discuss their research surrounding chemotherapy-induced peripheral neuropathy, which has been paramount in making further steps towards managing this often life-changing side effect.
They discuss why CIPN was often viewed by clinicians as the price to pay for curing cancer when there was no effective intervention on the horizon, and that patients are often unaware of the side effect until they begin to suffer from it. Looking to the future, Raghav and Aish discuss cryocompression as a potential treatment option for CIPN, and why assessment and management protocols surrounding CIPN need to be reviewed.
In this episode, Rich chats with Dr Conleth Murphy, a consultant medical oncologist and Sue Glavin, Nurse Manager who are both leading the way in scalp cooling treatment at Bon Secours Hospital in Cork, Ireland.
They discuss how patient advocacy played a huge part in integrating scalp cooling into their side effect management practice. As well as the psychosocial impact that scalp cooling can have on patients. Both go into depth about how providing care can limit the impact of cancer on a patient both during and after their treatment.
In this episode, Rich firstly chats with Dr Jyoti Bajpai, an oncologist in Mumbai who prioritises providing precision symptom care for her patients, despite the 100+ patients she sees daily. They discuss Bajpai’s randomised controlled trial on scalp cooling, her discoveries on regrowth as a secondary endpoint, and the importance of treatment sequencing to reflect each individual patient’s definition of success.
Rich then speaks to Professor Masakazu Toi, a breast oncologist from the Kyoto University in Japan. We discuss his involvement in the HOPE Study – a multicenter controlled clinical trial on scalp cooling which was revolutionary in its investigation into the role of hair regrowth as well as hair retention.
In our first episode, Richard meets with Dr. Maryam Lustberg, Chief of Breast Medical Oncology at Yale Cancer Centre, and Dr. Corina van den Hurk of the Netherlands Comprehensive Cancer organisation. Maryam and Corina are both paving the way in side effect management for chemotherapy patients across the globe. We discuss their current research initiatives, their own personal connections with scalp cooling, and the need for better symptom management care, to improve patient's quality of life as well as their treatment.
In this podcast, CEO of Paxman Scalp Cooling Richard Paxman will be speaking to renowned oncologists, clinical researchers and medical thought leaders, to discuss how chemotherapy side effects impact on a patients physical and mental wellbeing - and ask, how is oncology care tackling these side effects?
He’ll be discussing the development and practice of side effect management across the globe, and challenging healthcare preconceptions about what patients want, in addition to what they medically need.
By investigating the true meaning of patient-centric-care and the barriers which present themselves along the way, we’ll be revealing the steps that the leaders in global oncology are taking to integrate truly individualised symptom management and improve quality of care for chemotherapy patients.
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www.paxmanscalpcooling.com/podcast