LaVette Page was a cottontop child who grew into a woman with honey blond tresses. Her hair had always been a primary trait of her physical appearance and identity.
Keeping her hair during chemotherapy was not rooted in vanity. It had to do more with her emotional security. Her hair was like a helmet.
“I didn’t want people to look at me and see cancer,” she said. “I wanted them to look at me and see LaVette. I wanted to hold onto something of my dignity. For me that was my hair.”
After being diagnosed in September 2023 with invasive ductal carcinoma that was both HER-2 positive and estrogen receptor positive, she learned that she would undergo a full range of breast cancer treatments – surgery then chemotherapy then radiation then aromatase inhibitor therapy. Page, who lives in Bowling Green, Kentucky, had heard about scalp cooling to preserve hair during chemotherapy, so she researched where it was available and learned that Vanderbilt-Ingram Cancer Center had installed a DigniCap Scalp Cooling System last year at its Belle Meade clinic.
She asked her medical oncologist, Brent Rexer, MD, PhD, at the Vanderbilt Breast Center at One Hundred Oaks, if she could receive her infusion treatments at Vanderbilt-Ingram Cancer Center Belle Meade.
“He managed to get me in,” Page said. “The center at Belle Meade took care of everything. I had already signed up with DigniCap and had done some of the legwork. I had checked on insurance. Janet Fuller there just took the ball and owned it.”
Fuller, MSN, RN, CPHON, ONS, assistant manager of Patient Care Services at Belle Meade, said Page had one of the best responses of the 20 women who have undergone scalp cooling since the infusion clinic began offering it in April 2023.
“We’ve seen mixed results,” Fuller said. “LaVette lost so little hair, she kept it in a pill bottle. She was very regimented in following what DigniCap had recommended for her to do to keep her hair. We’ve seen here that older people with thin hair to begin with have had less success with the machine. If you are a bit younger with thicker hair, you seem to have a better response.”
Page, who is 60, slept with a silk pillow, washed her hair once a week and combed her hair only once a day. She followed all the DigniCap recommendations. During her cancer treatment, she told few people about it – not even the 24 women in the Bible class she taught at her church.
“I teach a class where I needed to be effective in what I was doing,” Page said. “That’s engaging people’s minds and not giving them a distraction at the front of the classroom.”
The Food and Drug Administration first granted marketing approval for the DigniCap system for patients with breast cancer in 2015, then in 2017 the FDA expanded the authorization, making it the first cooling cap cleared for use in cancer patients with solid tumors, such as breast cancer, ovarian cancer and colorectal cancer.
The FDA granted the initial authorization after a medical study demonstrated that more than 66% of patients treated with the DigniCap system reported losing less than half their hair.
The cooling system constricts blood vessels in the scalp, which reduces the amount of chemotherapy that reaches cells in the hair follicles. The cold temperature also decreases the activity of the hair follicles and slows down cell division, making them less affected by chemotherapy, the FDA said in a release. The agency noted, however, that scalp cooling may not work with some chemotherapy regimens.
“Scalp cooling does extend the treatment time,” Page said. “That was a process. Each time, it was uncomfortable, but not intolerable. It was uncomfortable, for 16 to 18 minutes, then my scalp went numb. I didn’t feel anything once it reached that point.”
She said she’s grateful that she was able to secure a spot for scalp cooling.
“We don’t have enough spots for everybody who wants to do it because patients are on the scalp cooling machine for so long after their chemo treatments.” Fuller said. “Anywhere from an hour-and-a-half to three hours post treatment they have to be on the machine. It makes for a long day.”
Fuller and the other nurses do a great deal of logistic work to accommodate as many patient requests as possible. They also provide patients with the insurance billing codes and advise them to call their health insurance companies to check on reimbursement. Medicare covers the cost, and the National Comprehensive Cancer Network recommends it as a treatment option.
Karline Peal, MBA, RTT, associate operating officer of Vanderbilt-Ingram, led the initiative to begin the service after being recruited in 2020 from Northwestern Medicine in Chicago, which offered scalp cooling at select locations. She worked closely with Rachel Cloud, BSN, MBA, RN-BC, a nursing administrator, to set up the service.
“When I realized that some of our patients were dragging in self-coolers for their chemotherapy infusions to try to mitigate hair loss, I knew we had to figure out a way to make scalp cooling more accessible for our patients at Vanderbilt-Ingram,” Peal said. “I consulted with Rachel Cloud, and she quickly joined forces to make this possible with our nursing and patient care team. I was just a catalyst, but our nurses supported this from day one and remain eager to help expand it to more locations across our regional cancer centers.”
Page, who now shares more openly about her cancer journey, said people are shocked to learn she underwent chemotherapy because she never lost her hair.
“When you are a breast cancer patient, it can go any number of ways,” Page said. “The nurses treated both my cancer and my emotions. When they realized how important it was for me to complete that journey with my hair, they went the extra effort. When they saw the results, they celebrated along with me.”