A randomized pilot study recently published in Scientific Reports evaluated the use of electric hand warmers to improve comfort for breast cancer patients undergoing scalp cooling to prevent chemotherapy-induced alopecia. The study, conducted in Brazil and funded by Instituto Oncoclínicas, aimed to assess whether electric hand warmers could enhance thermal, sensory, and overall comfort for patients using scalp cooling systems during chemotherapy.
Scalp cooling has emerged as an effective method to reduce hair loss associated with chemotherapy, a side effect that can significantly impact quality of life for cancer patients. However, the cold temperatures required for scalp cooling often lead to discomfort, with up to 66% of patients reporting some degree of discomfort. This discomfort can contribute to discontinuation rates of 3-13% for scalp cooling. The researchers hypothesized that providing localized warmth via electric hand warmers could help counteract the cold and improve patient comfort and adherence.
The single-center, randomized study enrolled 40 women with stage I-III invasive breast cancer who were scheduled to receive neoadjuvant or adjuvant chemotherapy with scalp cooling. Patients were randomly assigned 1:1 to use electric hand warmers or observation (control) during their chemotherapy sessions. The primary endpoints were thermal comfort, sensory comfort, and overall comfort, assessed after each infusion using 5-point Likert scales.
To be eligible, patients had to be at least 18 years old with an ECOG performance status of 0-1. Key exclusion criteria included hemoglobin <10 g/dL, white blood cell count <1.5 x 10^3/L, platelet count <100 x 10^3/L, other malignancies within 5 years, pregnancy, severe medical conditions, and prior chemotherapy with scalp cooling. The study took place between April and October 2018.
Participants had a median age of 53 years. Most (67.5%) had completed higher education, and half had comorbidities. The most common chemotherapy regimen was dose-dense doxorubicin/cyclophosphamide followed by paclitaxel (55%). By breast cancer subtype, 67.5% were hormone receptor-positive/HER2-negative, 22.5% were triple-negative, and 10% were HER2-positive. The majority (55%) had stage II disease.
The electric hand warmer device used was the EnergyFlux Ellipse, with dual temperature settings of 42°C and 48°C. Patients in the intervention arm held a device in each hand throughout their time in the chemotherapy chair, starting at the lower temperature setting with the option to increase if desired.
The results showed significant benefits with use of the electric hand warmers. For thermal comfort, 79% of patients in the hand warmer group reported favorable responses compared to 50% in the control group (odds ratio 3.79, p<0.001). Sensory comfort was reported as satisfactory by 82% in the hand warmer group versus 74% in the control group, though this difference did not reach statistical significance (odds ratio 1.62, p=0.102). For overall comfort, 73% in the hand warmer group had favorable responses compared to 44% in the control group (odds ratio 3.44, p<0.001).
Importantly, age, degree of alopecia, and use of paclitaxel did not significantly impact the comfort measures. No patients reported heat discomfort or adverse events related to the hand warmers, and none dropped out due to heat intolerance. All patients took brief breaks (<30 minutes) from using the devices, primarily for restroom visits.
The study had some notable limitations. The sample size was relatively small at 40 patients. There was also a high discontinuation rate of 20% in the intervention group and 25% in the control group, exceeding the expected 15% attrition rate. However, all discontinuations were due to grade 2 alopecia rather than discomfort from scalp cooling. The researchers mitigated the impact of discontinuations by analyzing each chemotherapy session questionnaire as an individual data point.
Other limitations included the relatively young median age of 53 years, which limited assessment of the intervention's effects in older patients who may be more sensitive to temperature changes. The study also did not evaluate the potential impact of hand warmers on chemotherapy-induced peripheral neuropathy, which is sometimes managed with cold therapy approaches. Additionally, blinding was not feasible given the nature of the thermal intervention.
Despite these limitations, the authors concluded that use of electric hand warmers appears feasible and is associated with encouraging improvements in patient comfort during scalp cooling. They suggest the intervention could potentially help reduce discontinuation rates for scalp cooling. However, they note that effectiveness of hair preservation remains the primary driver of adherence to scalp cooling.
The researchers recommend that future studies explore the impact of electric hand warmers on patient adherence to scalp cooling, tolerance of the procedure, and overall quality of life during chemotherapy. They also emphasize the need to further evaluate potential adverse events in a broader patient population.
This pilot study provides initial evidence supporting the use of localized warming as a complementary therapy to improve the scalp cooling experience. If validated in larger trials, this simple intervention could enhance comfort and potentially increase utilization of scalp cooling to prevent chemotherapy-induced alopecia. For oncologists and oncology nurses, the findings suggest a low-risk option to consider for improving patient comfort during scalp cooling procedures.
However, several questions remain to be addressed before widespread clinical implementation. These include the optimal temperature settings and duration of hand warmer use, any impact on chemotherapy efficacy or side effects, cost-effectiveness considerations, and applicability to different chemotherapy regimens and patient populations. Additionally, direct comparisons to other comfort measures like blankets or warm beverages would be informative.
While encouraging, these results should be considered preliminary given the limitations of this small pilot study. Larger randomized trials are needed to confirm the benefits and further characterize the effects of electric hand warmers as an adjunct to scalp cooling. Oncology professionals should await more definitive evidence before routinely incorporating this approach, but may consider it on a case-by-case basis for patients experiencing significant discomfort with scalp cooling.
In summary, this innovative pilot study provides an initial proof-of-concept for using localized warmth to counteract the discomfort of scalp cooling during chemotherapy. If further validated, this simple intervention could potentially improve the scalp cooling experience and increase utilization of this important supportive care measure for cancer patients. The findings warrant larger follow-up studies to more definitively establish the role of electric hand warmers in optimizing scalp cooling protocols.
References
Landeiro LCG, Lopes Paim Miranda D, Mathias Machado R, et al. Electric hand warmer versus observation to avoid discomfort during scalp cooling for chemotherapy-induced alopecia prevention: a randomized study. Sci Rep. 2023;13(1):19555. Published 2023 Nov 9. doi:10.1038/s41598-023-46840-3
