Table 2.

Prophylactic recommendations For patients treated with TTFields and caregivers (24, 39, 41, 45, 46).

Prophylactic intervention	Recommendations For patients treated with TTFields and caregivers
Optimal shaving and preparation of the scalp to maximize transducer-skin contact and minimize erosions and other factors increasing the risk of infection	• Perform proper hand washing before preparing the scalp for array application • Shave the scalp every time arrays are changed using gentle but firm circular motions – complete hair removal is required for optimal adhesion • Use a clean, electric razor to avoid cuts • Mineral (baby) oil may be applied before shaving to allow for cleansing of the skin and facilitate removal of bacteria and scale
Removal of natural oils and any moisture (sweat) from the scalp prior to array placement	• Wash the scalp with mild, fragrance-free shampoo (e.g., baby shampoo) or dandruff shampoo • If no skin irritation is present, wipe the scalp with a gauze or cotton ball soaked in first aid isopropyl alcohol (70%) • Ensure scalp is completely dry before array placement
Careful application and removal of transducer arrays is crucial to decrease the risk of cutaneous irritation	• Change arrays at least every 3–4 days, or more frequently if they become wet or loosen (e.g., excessive sweating during warmer weather or after intense physical activity) • Apply mineral (baby) oil to the scalp to gently remove arrays; slowly and gently peel back the arrays from the skin – pulling the skin or forceful rubbing of the scalp to remove adhesive can contribute to skin breakdown and irritation so should be avoided • Alternatively, the arrays may be removed in a hot shower by rubbing in a body wash containing coconut oil causing them to slide off the scalp • Evaluate the skin and scalp for signs of irritation with every array change, and notify your doctor or nurse if there are signs of irritation (taking a picture of the affected area is advised)
Regular array repositioning to minimize direct pressure to the scalp and ensure avoidance of surgical scar lines	• At each array change, shift array placement by ~2 cm, ensuring that pairs of arrays are moved together • Move arrays back to original position at subsequent change • Avoid ceramic disc placement immediately over scars or surgical screws • Wear breathable headwear to avoid overheating