Abstract PS9-70: Identifying barriers and facilitators to scalp cooling use through a national survey of the awareness, practice patterns, and attitudes of oncologists toward scalp cooling
Authors: Novice Madison , Novice Taylor , Jeruss Jacqueline , Johnson Kyle , Burness Monika 
Published: February 2021

Abstract
Background: Over the past decade, there has been a growing body of literature supporting the use of scalp cooling therapy (SCT), or “cold caps”, for reducing hair loss due to chemotherapy. Despite guidelines supporting its use in certain malignancies, and while uptake of SCT has increased across the United States, its use is still not wide spread. While literature has examined the reasons driving patient use of SCT, there is less known about factors influencing physician preferences regarding use of SCT. We hypothesized that degree of physician knowledge of scalp cooling and availability of SCT may contribute to lower patient use of SCT. Oncologists’ knowledge, practice patterns and attitudes regarding SCT were examined in this study. Methods: Our 33-question survey was distributed through ASCO’s Research Survey Pool to a nationally representative, random sample of 600 physicians and advanced practice providers in medical oncology, surgical oncology, gynecology, and urology, in February 2020. Reminders were sent every 1-2 weeks and the survey closed in June 2020. Main outcome measures included oncologists knowledge of SCT, reported initiating conversations about SCT with patients, and degree of support for the use of SCT. The survey also investigators barriers to their support of SCT and scalp cooling options offered at their facilities. The respondents were a representative mix of provider designation, cancers treated, practice setting (academic v private practice), years in practice, and practice area (urban v suburban v rural). Results:158 oncologists provided responses (158/600, response rate= 26.3%). Only 1.9% had no knowledge of scalp cooling, whereas 45.2% were aware of scalp cooling but were not very familiar with it, and the remaining 52.9% were very familiar with it. While 60% of providers reported being in favor of scalp cooling always/most of the time, only 25.8% initiated discussions about SCT always/most of the time. Providers who reported being very familiar with SCT were significantly more likely to initiate a discussion about SCT all or most of the time with their patients and to be in favor of SCT, compared to those who were not very familiar with SCT (46.3% v 2.9% P= &lt;.0001; 76.8% v 44.3 P=&lt;.0001). Providers who had read literature about SCT in the past two years were also significantly more likely to initiate a discussion about SCT all or most of the time with their patients and be in favor of SCT compared with those who had not read literature in the past two years (38% v 3.9% p value=&lt;.0001;72.0% v 42.3% p value=&lt;.0001). Physicians who worked at institutions that offered machine scalp cooling were more likely to initiate conversations with patients about scalp cooling and be in favor of scalp cooling than those at institutions who do not offer it (49.2%, 11.8% p value &lt;.0001; 78% v 51.6% p value .0001). Financial strain for the patient was the number one physician-reported reason for not initiating SCT conversations with their patients, and for not being in favor of scalp cooling. Conclusion: We found that physician lack of familiarity with scalp cooling was correlated with lower likelihood of discussing or recommending SCT with patients. Providers more familiar with scalp cooling, either through experience, exposure to current literature, or working at an institution that provides machines, were more likely to initiate conversations with patients on scalp cooling and to support the use of SCT. These findings suggest that provider knowledge of and access to scalp cooling therapy significantly influences the advice given to patients with regard to SCT. This study of a nationally representative sample of oncologists has identified provider-specific barriers to broader implementation of SCT.
Citation Format: Madison Novice, Taylor Novice, Jacqueline Jeruss, Kyle Johnson, Monika Burness. Identifying barriers and facilitators to scalp cooling use through a national survey of the awareness, practice patterns, and attitudes of oncologists toward scalp cooling [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS9-70.