Kathy Bell didn't want to see a sick person in the mirror. Nor did she want others to view her as a cancer patient in need of sympathy.
Having been stopped in her tracks by a breast cancer diagnosis in 2015, the Melbourne executive decided to do everything she could to maintain some sense of her normal self.
She ate well, exercised, worked when she had energy, and in a bid to prevent hair loss from chemotherapy, she tried scalp cooling.
The technology involved putting her head in a refrigerated cap for up to four hours each time she had chemo.
It was an uncomfortable experience made easier by a pre-treatment sedative, pre-warmed blankets at Epworth hospital where she was having treatment, and a colouring book to pass the time.
New research suggests Ms Bell was lucky. She is one of about 50 per cent of patients who respond well to scalp cooling treatment to prevent hair loss - one of the most distressing side effects of chemotherapy reported by patients.
Two studies of the technique published on Wednesday reported success rates of 51 to 66 per cent among breast cancer patients in the US. Success was defined as less than 50 per cent hair loss.
While side effects included headaches, dizziness, nausea, and skin ulceration, one study found those who used scalp cooling reported lower rates of feeling dissatisfied with their bodies after treatment.
The two studies were funded by companies who make the cool cap devices and follow a small Australian study of 24 patients at Cabrini Hospital in Melbourne. It found 12 per cent of patients who had scalp cooling had no hair loss, 23 per cent had minimal hair loss and 65 per cent had moderate hair loss.
The companies manufacturing the refrigeration caps, which cost about $40,000 to buy, say they reduce blood flow to hair follicles that include rapidly dividing cells - the sort of cells chemotherapy target and kill.
But for this very reason, there has been a concern the technique could open up a "sanctuary site" for cancer to spread to. In 2011, Canadian doctors reported that two women with breast cancer who had had scalp cooling were diagnosed with scalp metastasis years after their initial treatment. However the researchers concluded that scalp cooling was unlikely to have caused this.
Two other studies have since compared scalp metastasis in hundreds of patients who had scalp cooling and a group who did not. They found no difference in the incidence of scalp cancers between the two groups.
Despite this, one of the American studies reported this week in JAMA is now tracking its participants for five years to monitor them for cancer recurrence, including in their scalps.
Ms Bell said while some people would find scalp cooling too uncomfortable or not worth the effort (it added time to her visits to hospital), she was grateful for keeping nearly all of her hair and she experienced no side effects. She is now hoping it will be offered more widely, including in the public hospital system.
"I don't see psychological and physical health as separate," she said. "If you can support someone's psychological health during cancer treatment, it can make a big difference to the person's quality of life and that may well have some flow on clinical benefit."