Management of Chemotherapy-Induced Alopecia through Scalp Cooling

Introduction

Scalp cooling has been used since the 1970s to mitigate chemotherapy-induced alopecia (CIA), a common and emotionally challenging side effect. Although this technique is widespread in Europe, its adoption in the United States has been slower due to safety concerns, such as the risk of scalp metastasis. Despite this, several recent studies have demonstrated the efficacy and safety of these systems in patients undergoing chemotherapy for solid tumours.

Objective

The primary aim of this study is to review the efficacy and safety of scalp cooling systems, particularly the Dignicap and Paxman devices, in preventing hair loss in patients undergoing chemotherapy.

Methods

This study reviews retrospective and prospective research evaluating the use of different cooling systems. These include manual systems (such as Penguin and Arctic) and automatic ones (Dignicap and Paxman). The studies assess hair retention through patient self-assessment and standardised alopecia criteria, as well as safety in terms of adverse effects and the risk of scalp metastasis.

Results

The study results indicate that scalp cooling is more effective for taxane-based chemotherapy regimens than for those based on anthracyclines. In the SCALP study, 50.5% of patients who used cooling retained their hair, compared to 0% in the control group. Overall efficacy varied depending on the type of chemotherapy and the cooling method used.

The table compares three studies on scalp cooling:

1. 1. Nangia (Paxman):
      • • 51% hair preservation with cooling.
      • • 59% with taxanes and 16% with anthracyclines.

1. 1. Rugo (Dignicap):
      • • 66% success with taxane-based chemotherapy.

1. 1. Rice (Penguin Cold Caps):
      • • 61% overall preservation.
      • • 50%-84% with taxanes and 20%-43% with anthracyclines.

Cooling was more effective with taxane-based chemotherapy across all studies.

Analysis

Scalp cooling offers a promising option to reduce chemotherapy-induced alopecia, though effectiveness largely depends on the type of chemotherapy and cooling technique used. Additionally, certain factors that influence effectiveness, such as age and hair type, were identified.

Efficacy of Scalp Cooling

The reviewed studies indicate that cooling is significantly more effective in patients receiving taxane-based chemotherapy, with success rates of up to 66% in hair retention. However, effectiveness decreases considerably with anthracycline-based regimens.

Safety of Scalp Cooling

The most commonly reported adverse effects include scalp pain, chills, headaches, and nausea, but these were mild (grade 1 or 2) and well tolerated by most patients. Studies do not show a significant increase in the risk of scalp metastasis with cooling use.

Study Heterogeneity

There is some variability in study results due to differences in chemotherapy types, cooling methodologies, and patient populations. This suggests that cooling outcomes may depend on factors such as application technique and cancer type.

Quality of Life and Psychological Outcomes

Studies showed that patients who managed to preserve their hair through scalp cooling experienced a better quality of life in terms of self-esteem and body image. Additionally, patients in the control group without cooling reported higher levels of dissatisfaction with their appearance and more emotional distress due to alopecia.

Key Data

• • Reduction in Alopecia Risk: Scalp cooling reduced the incidence of alopecia in approximately 50% of patients treated with taxanes.

• • Relative Risk (RR): The SCALP study showed a significantly lower relative risk of alopecia in the cooling group compared to the control group, with notable differences across chemotherapy types.

• • Number of Participants: The SCALP trial included 182 patients, with a 2:1 randomisation between the cooling group and the control group.

• • Chemotherapy Type: Cooling was more effective in patients treated with taxane-based chemotherapy (59%) compared to those treated with anthracyclines (16%).

• • Adverse Events: Side effects were mild and transient, with only a small percentage of patients discontinuing treatment due to discomfort from the cold.

Conclusion

Scalp cooling is an effective and safe option for preventing chemotherapy-induced alopecia, especially in patients treated with taxanes. Despite study heterogeneity, available data suggest that cooling improves patients’ quality of life by reducing hair loss. The risk of scalp metastasis is low, and adverse effects are generally tolerable. These findings support the broader implementation of scalp cooling in patients seeking to mitigate chemotherapy-associated hair loss.

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