TTFields for Glioblastoma: How to Maximize Wear Time and Comfort

Almost everyone feels overwhelmed when they first encounter a TTFields device, says Nitesh V. Patel, MD, a brain tumor neurosurgeon and the codirector of the neurosurgical oncology program at Hackensack Meridian Jersey Shore University Medical Center in Hackensack, New Jersey. “But eventually, for a lot of patients, it becomes second nature. Just remember you’re not alone, and your routine will become faster over time,” he says.

How to Build Daily Wear Time

And the more time the therapy is on, the more opportunity it has to do its job, explains David Peereboom, MD, a neuro-oncologist at Cleveland Clinic in Cleveland, Ohio. “While 75 percent is an important benchmark, even higher use may provide additional benefit when possible,” he says. “Aim for over 90 percent wear time when feasible, while recognizing that occasional interruptions are unavoidable.”

Start Slow and Adjust as Needed

You don’t have to start with 18 hours a day, says Dr. Peereboom. “If wearing the device for long stretches feels difficult at first, it can be easier to build up gradually rather than focusing only on the final target,” he notes. “Setting small, realistic goals can make the process more manageable.”

You can reach your 75 percent goal a few different ways, says Dr. Chirag Patel, who has conducted research on TTFields. “For example, one patient may consistently have the device turned on for 18 hours a day, every day of the week,” he says. Or you may have the device turned on 24 hours a day for three days straight, then take the fourth day off to shave your scalp and have a built-in day off from the device, and then repeat the cycle again, he says.

You can also wear TTFields while you sleep, getting several hours of easy wear time overnight, says Nitesh Patel. “Sleep is your best ally.”

Track Your Wear Time

Your TTFields device tracks how much time you use it (“on” time) and creates a report at the end of every month, says Chirag Patel. You can get this report through a connected app or from your provider, he says.

“[This information] can be used to identify trends that may be preventing the patient from achieving the recommended 75 percent ‘on’ time,” says Chirag Patel. It can also show when you wore it most, which can help you adjust your wear schedule so you can use it more, he says.

Stay Prepared

Scalp Care

Here are some scalp care tips to follow while using TTFields.

“Keep an eye on your skin and have family members also keep an eye on it,” says Nitesh Patel. “If any irritation is present, let your medical team know.”

Chirag Patel encourages his patients to send well-lit pictures of any early signs of skin irritation on their scalp to his clinic team. “This allows me to review the images and determine next steps, which may include providing guidance to the patient,” he says. These recommendations may include:

• Slightly repositioning the location of the electrodes
• Prescribing a topical steroid cream or antibiotic
• Referral to a dermatologist

How to Manage Heat and Everyday Comfort

If your scalp gets sweaty, the salt from the sweat can disrupt the delivery of the electric fields, he says. “This can cause a brief zap-like sensation, which we want to avoid on the patient’s behalf.”

Reschedule Exercise

• Avoid excessive outdoor activities when the sun is out.
• Take your daily walk at dawn or dusk.
• Consider going to an air-conditioned building (like a grocery store or shopping mall) to get your daily steps in.
• Try a neck fan to keep you cool during the day and reduce the risk of sweating.

Create a Cool and Comfortable Sleep Space

To sleep better with TTFields, choose light bedding, light sleep clothes, and keep a fan nearby, says Nitesh Patel.

Some people also complain that the wires connecting the electrodes to the TTFields device can feel uncomfortable between their neck and pillow, says Chirag Patel. He suggests using soft tape to change the angle of the wire that’s bothering you so it doesn’t go down the back of your neck but off to the side.

Chirag Patel also recommends making sure your wires have enough slack so they don’t pull when you move during sleep.

Check Electrode Placement

Navigating Public Settings

When you wear your TTFields device out in public, it’s normal to feel self-conscious. “Wearing a visible medical device can affect confidence, privacy, and comfort in social situations. Those feelings are understandable,” says Peereboom.

If you go out and about with your TTFields device, you can wear a cover over your scalp. But keep it loose, like a beanie, hood, or scarf, says Nitesh Patel. If you want to keep the device tucked away, you can carry it in a backpack, shoulder bag, or purse, he says.

You can also schedule treatment breaks around important events, as long as you have at least 75 percent “on” time over a one-month period, says Chirag Patel. For example, if you miss six hours of wear time for a wedding, you can make it up later.

Peereboom encourages his patients to think about what matters most to them: comfort, discretion, convenience, or openness with others. “Different people handle this differently,” he says.

It may also help to practice a short response for public situations, such as saying that the device is part of your brain tumor treatment and helps you stay on therapy, says Peereboom. “Having a prepared answer can reduce anxiety,” he says.

And remember, you don’t have to navigate these feelings on your own. “Through support groups and peer mentors, many patients benefit from talking with others who have used the device and can share real-life strategies,” Peereboom says.

Chirag Patel often refers his patients to the Optune Gio® Buddy program, which pairs you with someone else who uses TTFields.

“Just remember, you control the narrative, and connecting with others who may be going through similar points in their lives is important,” says Nitesh Patel. “Support is what helps you get through.”

Disclosure: Chirag B. Patel receives clinical trial support from Novocure, Ltd. as the MD Anderson site principal investigator of the phase 3 international multicenter, two-arm, randomized, double-blind, placebo-controlled study of TTFields + temozolomide + (either pembrolizumab or placebo) in patients with newly diagnosed glioblastoma. He has received royalties from a laboratory-research-based patent related to TTFields (US-11529511-B2).