Introduction
Chemotherapy-induced alopecia (CIA) is one of the most common and distressing side effects of breast cancer treatment. Hair loss, although temporary, can negatively affect patients' self-image and emotional well-being. This study addresses the efficacy of scalp cooling (SC) in reducing CIA in patients with early breast cancer receiving modern chemotherapy regimens.
Target
The aim of the study was to determine the efficacy of scalp cooling in patients with early breast cancer receiving modern chemotherapy, in order to inform future patients' decision whether or not to use this method. In addition, the impact of hair loss on mood and body image was explored.
Methods
The study was a prospective cohort trial involving 60 patients with stage I-III breast cancer who were recommended to receive taxane- or anthracycline-taxane-based chemotherapy regimens. Patients were randomised to receive scalp cooling at two different temperatures (3°C and 5°C) using the DigniCap system. The primary objective was to assess the proportion of patients who experienced minimal hair loss, defined as grades 1 or 2 on the Dean scale.
Results
- Scalp Cooling Effectiveness: 33% of patients reported minimal hair loss, not reaching the primary endpoint of the study. The highest success rate was observed in patients who received chemotherapy alone with taxanes (45%), while those who received anthracyclines and taxanes together showed the lowest efficacy (20%).
- Scalp Cooling Safety: Adverse events related to scalp cooling were low grade and resolved without serious complications. The most common side effects included mild scalp pain, headache and dizziness.
Analysis
- Scalp Cooling Effectiveness: Although scalp cooling showed some effectiveness, especially in taxane-based treatments, the primary goal of minimal hair loss was not achieved in the general population. Efficacy varied significantly according to the type of chemotherapy received, with lower results in anthracycline-taxane regimens.
- Scalp Cooling Safety: Scalp cooling was well tolerated, with mild and transient adverse events. Adherence to device use was higher in patients treated with taxanes alone.
- Heterogeneity of the studies: No significant difference in efficacy was observed according to cooling temperature (3°C vs. 5°C). The variability in results suggests that other factors, such as the patient's subjective perception, may influence the assessment of cooling efficacy.
- Quality of Life and Psychological Outcomes: Although there was a significant improvement in anxiety levels in patients with minimal hair loss, no significant differences were observed in depression or body image. This suggests that hair loss is only one of many factors affecting emotional well-being during chemotherapy.
Key Facts
- Alopecia Risk Reduction: 33% of patients experienced minimal hair loss in the general population; this percentage increased to 40% in those who completed the entire treatment with scalp cooling.
- Relative Risk (RR): The study does not specify an exact RR, but other studies mentioned in the discussion report an RR of 0.38 in the reduction of chemotherapy-induced alopecia.
- Number of Participants: 60 patients.
- Type of chemotherapy: Taxane-based regimens and anthracycline-taxane combinations.
- Adverse Events: They included mild scalp pain, headache, dizziness and rash, all low-grade and resolving within a few days.
Conclusion
The study confirms that scalp cooling can be effective in reducing chemotherapy-induced alopecia in patients receiving taxane-based regimens, with a recommendation for routine use in these cases. For patients receiving combined anthracycline-taxane regimens, an individualised approach is suggested, considering the low efficacy and additional time required for treatment.
Document Analysis Method:
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