Association Between Use of a Scalp Cooling Device and Alopecia After Chemotherapy for Breast Cancer

Abstract

IMPORTANCE Chemotherapy-induced alopecia is a common and distressing adverse effect. In previous studies of scalp cooling to prevent chemotherapy-induced alopecia, conclusions have been limited.OBJECTIVES To evaluate whether use of a scalp cooling system is associated with a lower amount of hair loss among women receiving specific chemotherapy regimens for early-stage breast cancer and to assess related changes in quality of life. DESIGN, SETTING, AND PARTICIPANTSA prospective cohort study conducted at 5 US medical centers of women with stage I or II breast cancer receiving adjuvant or neoadjuvant chemotherapy regimens excluding sequential or combination anthracycline and taxane (106 patients in the scalp cooling group and 16 in the control group; 14 matched by both age and chemotherapy regimen). The study was conducted between August 2013 and October 2014 with ongoing annual follow-up for 5 years.EXPOSURES Use of a scalp cooling system. Scalp cooling was initiated 30 minutes prior to each chemotherapy cycle, with scalp temperature maintained at 3°C (37°F) throughout chemotherapy and for 90 minutes to 120 minutes afterward.MAIN OUTCOMES AND MEASURES Self-estimated hair loss using the Dean scale was assessed 4 weeks after the last dose of chemotherapy by unblinded patient review of 5 photographs. A Dean scale score of 0 to 2 (Յ50% hair loss) was defined as treatment success. A positive association between scalp cooling and reduced risk of hair loss would be demonstrated if 50% or more of patients in the scalp cooling group achieved treatment success, with the lower bound of the 95% CI greater than 40% of the success proportion. Quality of life was assessed at baseline, at the start of the last chemotherapy cycle, and 1 month later. Median follow-up was 29.5 months. RESULTS Among the 122 patients in the study, the mean age was 53 years (range, 28-77 years); 77.0% were white, 9.0% were black, and 10.7% were Asian; and the mean duration of chemotherapy was 2.3 months (median, 2.1 months). No participants in the scalp cooling group received anthracyclines. Hair loss of 50% or less (Dean score of 0-2) was seen in 67 of 101 patients (66.3%; 95% CI, 56.2%-75.4%) evaluable for alopecia in the scalp cooling group vs 0 of 16 patients (0%) in the control group (P < .001). Three of 5 quality-of-life measures were significantly better 1 month after the end of chemotherapy in the scalp cooling group. Of patients who underwent scalp cooling, 27.3% (95% CI, 18.0%-36.6%) reported feeling less physically attractive compared with 56.3% (95% CI, 31.9%-80.6%) of patients in the control group (P = .02). Of the 106 patients in the scalp cooling group, 4 (3.8%) experienced the adverse event of mild headache and 3 (2.8%) discontinued scalp cooling due to feeling cold.CONCLUSIONS AND RELEVANCE Among women undergoing non-anthracycline-based adjuvant chemotherapy for early-stage breast cancer, the use of scalp cooling vs no scalp cooling was associated with less hair loss at 4 weeks after the last dose of chemotherapy. Further research is ne...

Permanent Chemotherapy-Induced Alopecia in Patients with Breast Cancer: A 3-Year Prospective Cohort Study

“…Our study indicates that PCIA, primarily due to incomplete hair regrowth, is very common in patients with breast cancer even after 3 years of follow‐up. Although scalp cooling may prevent hair loss, the success rate is not yet optimal (20%–50%) . Clinicians should be aware of this distressing adverse event and develop supportive care strategies to prepare patients and minimize the impact on well‐being.…”

CDK4/6 inhibition mitigates stem cell damage in a novel model for taxane‐induced alopecia

“…As many as 8% of patients have been found to be at risk of rejecting chemotherapy due to the psychosocial burden imposed by chemotherapy-induced alopecia, which is detrimental to patient selfesteem, body image and quality of life (McGarvey et al, 2001) especially when the effects of chemotherapy are permanent (Freites-Martinez et al, 2019). The only currently available preventive treatment for chemotherapy-induced alopecia is scalp cooling, whose clinical efficacy is as yet unsatisfactory and difficult to predict, especially with taxane chemotherapy-induced alopecia (Friedrichs & Carstensen, 2014;Cigler et al, 2015;Rugo et al, 2017;Rice et al, 2018). Furthermore, scalp cooling does not extend protection against hair loss to other body sites of cosmetic, cultural, religious and psychosocial relevance, e.g.…”

Scalp hypothermia as a preventative measure for chemotherapy‐induced alopecia: a review of controlled clinical trials

“…Of the 182 breast cancer subjects receiving anthracycline or taxane‐based therapy, 50.5% of patients in the scalp cooling group showed hair preservation; whereas none (0%) of non‐scalp‐cooled patients retained their hair ( P = 0.0001%) . In a similar manner, Rugo et al . discovered that 67 of 101 patients (66.3%) in their scalp cooling group achieved less than 50% hair loss compared to 0 of 16 patients (0%) in their control group ( P < 0.001).…”