CHEMOTHERAPY-INDUCED ALOPECIA

YAN LI, RN, BSN, MBAUNIVERSITY OF SAN FRANCISCO

BACKGROUND - STATISTICAL SIGNIFICANCE▪ 14.1 million new cancer cases were diagnosed, and 8.2 million people died from

cancer in 2012; by 2025, 19.3 million cancer patients are estimated to be diagnosed each year ( Centers for Disease Control and Prevention, 2016).

▪ Chemotherapy-induced hair loss occurs with an estimated incident of 65% in patients having chemotherapy (Trüeb, 2010).

▪ Forty-seven percent of female patients believe hair loss is the most traumatic aspect of chemotherapy, and 8% of them would decline chemotherapy because of the fears of hair loss (Trüeb, 2010).

▪ Scalp cooling is by far the most effective method of reducing chemotherapy-induced hair loss (Breed et al, 2011).

BACKGROUND– COLD CAPS▪ A majority of the clinical studies on

Scalp Cooling to date have been done in Europe.

▪ Scalp cooling begins to grow in popularity in the US.

▪ Cold caps’ availability in Northern California: University of California, San Francisco, Helen Diller Family Comprehensive Cancer Center (DigniCap, 2016)

SEARCH PROCESS

CochranceCINAHLPubMedDynamed

Evidence-Based Journals

Key words: chemotherapy,

alopecia, hair loss, cold caps, scalp cooling,

penguin capYear: 2010-2016

Language: English

The yield of the search was 77

articles.Five articles were

selected.

REVIEW OF EVIDENCESTUDY DESIGN SAMPLE OUTCOME

STUDY DESIGN SAMPLE OUTCOME

Kargar, Sarvestani,

Khojasteh, and Heidari

(2011)

 

 

 

A quasi-experimental study A total number of 63 patients aged

16-59 years (mean 35 ± 5·5 years)

The application of cold caps

peculiar to the study is an

effective method for preventing

alopecia in patients

undergoing chemotherapy

Jo, Kim, Kwon,

and Myung (2015)

 

A Systematic Review and Meta-analysis Eight randomized controlled trials

and nine controlled clinical trials

involving 1,098 participants

Scalp cooling significantly

reduced the risk of CIA

Van Den Hurk et

al. (2012)

 

Logistic Regression Analysis Study 1411 patients were registered in the

Dutch Scalp Cooling Registry.

Scalp cooling results were positive

for most regimens, except for those

needing TAC.

REVIEW OF EVIDENCESTUDY DESIGN SAMPLE OUTCOME

STUDY DESIGN SAMPLE OUTCOME

Komen et al.

(2013)

Literature Review The literature search identified

192 reports, of which 32

studies were considered

relevant.

The effectiveness of scalp

cooling for hair preservation

varies by chemotherapy type

and dose, and probably by the

degree and duration of cooling

Cigler et al.

(2015)

Experimental Study Twenty patients

completed treatment and

had evaluable data.

Cold caps appear to be effective

in preventing CIA among the

majority of women undergoing

treatment with TC

chemotherapy.

LEVEL

Kargar,

Sarvestani,

Khojasteh, and

Heidari (2011)

Jo, Kim,

Kwon, and Myung

(2015)

Van Den Hurk

et al. (2012)

Komen et al.

(2013)

Bausewein et al. (2011)

Level 1: Systematic Review or Meta- Analysis or a Randomized Controlled Trial (RCT)

X

Level 2: Quasi Experimental X X X

Level 3: Non-Experimental or Qualitative studies

X

FRAMEWORKORLANDO’S NURSING PROCESS DISCIPLINE THEORY▪ 1) function of professional nursing;

▪ 2) Patients’ presenting behavior;

▪ 3) immediate reaction;

▪ 4) nursing process discipline;

▪ 5) nursing process improvement (Orlando, 1961).

THE UCSF SYMPTOM MANAGEMENT THEORY (SMT)

▪ 1) the symptom experience;

▪ 2) symptom management strategies,

▪ 3) symptom outcomes (Humphreys et al., 2008).

PROJECT OVERVIEW

▪ Current Situation:

Lacking knowledge on the scalp cooling system and insurance coverage leads to the lower use of cold caps. There is only one hospital in Northern California providing Cold Caps during the chemotherapy.

▪ Future State:

Increasing Cold Caps use to prevent chemotherapy-induced alopecia in the oncology clinic.

The stakeholders included manufacturers, regulators, health care providers, clinicians and patients.

GAP ANALYSIS

• Getting support from management level • Developing cold caps use policy and protocol

Management level

• Targeting education of chemotherapy patients about this prevention.

Providers

• Offering financial program who can't afford but interested• Advertising and Presenting this new intervention to more

providers and patients.Organization

AIM▪ The AIM statement: to prevent chemotherapy induced alopecia (hair loss) by

increasing the use of the scalp cooling system or cold caps.

▪ What are we trying to accomplish? To prevent chemotherapy induced alopecia

▪ Why is it important? Hair loss is one of the most emotionally challenging side effects for cancer patients that affects their quality of life (Trüeb, 2010).

▪ Who is the specific target population? Chemotherapy patients

▪ When will this be completed? Oct, 2016 – Apr, 2017

▪ How will this be carried out? Reaching out our director, nursing manager of our clinic and manufacturers to build the connection for increasing understanding the benefits of scalp cooling system.

DETAILED STATEMENT – SWOT ANALYSIS

▪ STRENGTHS: quality improvement, outstanding medical staff, support from administration, patients’ interests.

▪ WEAKNESSES: increasing healthcare costs to train employees on the knowledge and utilization of cold caps. The workload for clinicians will increase. Insurance coverage will be a big challenge for patients.

▪ OPPORTUNITIES: the new scalp cooling technology initiatives available to chemotherapy patients in our healthcare organization.

▪ THREATS:. Our competitor hospital, University of California, San Francisco Medical Center, has been using cold caps for their chemotherapy patients to reduce hair loss.

GANTT CHART

TIME AND COST SUMMARYTIME:

▪ Average chemotherapy takes 3-6 mons

▪ Average chemotherapy treatment are weekly

COST:

▪ $300-$500 per infusion (according to treatment time)

EVALUATION PLAN▪ The two measures used to evaluate the success of the project are:

▪ 1, Patients’ knowledge of cold caps to prevent chemotherapy induced alopecia – developing a cold cap evaluation questionnaire

▪ 2, Utilization rate of cold caps in our clinic – “0” % at this time.

NEW JOURNEY IN 2014 WE LEARNED A PATIENT WAS SUCCESSFUL WITH INSURANCE!

▪ I wanted to let you know that after denying my claim for cold caps, Anthem Blue Cross reversed themselves and paid. Below are the procedure and dx codes that did the trick. The first time they denied I called up and asked for the basis of the denial and checked what code they had used. They had changed the procedure code to an unspecified code and denied on that. My appeal was for them to process as the doctor had ordered. They did and paid ($1073 out of $1700 submitted). Please encourage others with and without Blue Cross to submit. Every time someone gets paid, it is a victory.

▪ Cranial prosthesis A9282

▪ dx alopecia for chemotherapy 704.00

IN 2015, SUCCESSFUL STORY

▪ My oncologist's prescription stated that it was for a "Full Hair Prosthesis" for chemo induced alopecia, dx. code 179.9. When I telephoned my insurance company, they told me they would cover up to $1,500 for the cost of a wig.

▪ After I completed chemo, I submitted the prescription, an invoice from MSC-Worldwide, and copies of my credit card statements showing the monthly fees I paid. (I submitted nothing about the deposit.) The insurance company first rejected my submission with no explanation code. I followed up by telephone and was told they rejected it because it was for a rental, not a purchase. I argued that no one told me about a rental exclusion etc. and they very nicely said that they would resubmit the claim, which much to my surprise, they then paid!

CONCLUSION▪ Increasing Cold Caps use to prevent chemotherapy-induced alopecia is an essential

issue for treatment of cancer patients undergoing chemotherapy.

▪ Getting support and developing a cold caps related policy and protocol should be a priority;

▪ Providing education to chemotherapy patients about this prevention to alopecia is the key to improve the utilization of scalp cooling system or cold caps to prevent chemotherapy-induced alopecia.

▪ Reducing and managing side effects is one of the biggest parts of cancer treatment. Supportive care and symptoms management are the key to allowing patients to get through chemotherapy with a good quality of life

REFERENCES▪ Breed W, Van den Hurk C, Peerbooms M (2011). Presentation, impact and prevention of chemotherapy-

induced hair loss: Scalp cooling potentials and limitations Expert Review of Dermatology, 6(1):109-25▪ Centers for Disease Control and Prevention. (2016). Global Cancer. Retrieved from

http://www.cdc.gov/minorityhealth/populations/REMP/asian.html▪ Cigler T, Isseroff D, Fiederlein B et al (2015) Efficacy of scalp cooling in preventing chemotherapy-induced

alopecia in breast cancer patients receiving adjuvant docetaxel and cyclophosphamide chemotherapy. Clin Breast Cancer 15(5): 332–4. doi: 10.1016/j.clbc.2015.01.003

▪ Dodd M, Janson S, Facione N, Faucett J, Froelicher ES, Humphreys J, Lee K, Miaskowski C, Puntillo K, Rankin S, Taylor D. (2001). Advancing the Science of Symptom Management. Journal of Advanced Nursing, 33(5), 668-676.

▪ Humphreys J, Lee KA, Carrieri-Kohlman V, Puntillo K, Faucett J, Janson S, Donesky-Cuenco D. Theory of symptom management. In: Smith MJ, Liehr PR, editors. Middle range theory for nursing. 2nd. New York, NY: Springer; 2008. pp. 145–158.

▪ Johns Hopkins Hospital/The Johns Hopkins University (2012). Research evidence appraisal tool. Johns Hopkins nursing evidence-based practice: Model and guidelines (2nd ed., pp. 237-240). Indianapolis, IN: Sigma Theta Tau International Honor Society of Nursing.

▪

REFERENCES▪ Jo, S. J., Kim, D. H., Kwon, O., & Myung, S. K. (2015). Efficacy of interventions for prevention of chemotherapy-induced

alopecia: A systematic review and meta-a nalysis (H. Shin, Ed.). International Journal of Cancer, 136(5), E442-54. doi:10.1002/ijc.29115

▪ Kargar, M., Sarvestani, R. S., Khojasteh, H. N., & Heidari, M. T. (2011). Efficacy of penguin cap as scalp cooling system for prevention of alopecia in patients undergoing chemotherapy. Journal Of Advanced Nursing, 67(11), 2473-2477. doi:10.1111/j.1365-2648

▪ Komen MM, Smorenburg CH, van den Hurk CJ, Nortier JW (2013) Factors influencing the effectiveness of scalp cooling in the prevention of chemotherapy-induced alopecia. Oncologist 18(7): 885-91 doi:10.1634/ theoncologist.2012-0332

▪ Orlando, I. J. (1961). The dynamic nurse-patient relationship: Function, process and principles. New York: G. P. Putman's Sons.

▪ Trüeb, R.M. (2010). Chemotherapy-induced hair loss. Skin Therapy Lett., 2010 Jul-Aug; 15(7):5-7

▪ Van den Hurk, C. J., Peerbooms, M., van de Poll-Franse, L. V., Nortier, J. W., Coebergh, J. W., & Breed, W. P. (2012). Scalp cooling for hair preservation and associated characteristics in 1411 chemotherapy patients - Results of the Dutch Scalp Cooling Registry. Acta Oncologica, 51(4), 497-504. doi:10.3109/0284186X

▪ Young A & Arif A.(2016). The use of scalp cooling for chemotherapy-induced hair loss. British Journal of Nursing, 2016 May 26;25(10):S22-7. doi: 10.12968/bjon.2016.25.10.S22

Questions ?THANK YOU