Two studies published in the February 14 issue of JAMA showed that using a scalp cooling device before, during, and after chemotherapy reduced hair loss among women with breast cancer.
Chemotherapy-induced hair loss is rated as one of the most distressing adverse effects of chemotherapy. Scalp cooling is hypothesised to reduce blood flow to hair follicles and reduce uptake of chemotherapeutic agents.
Modern methods to prevent hair loss use devices that circulate fluid in a cooling cap using refrigeration. A cap is placed on the patient prior to chemotherapy and does not have to be changed or removed until the treatment is completed. Although scalp cooling devices have been used to prevent alopecia, efficacy has not been assessed in a randomised clinical trial.
In one study, Julie Nangia, MD, Baylor College of Medicine, Houston, Texas, and colleagues randomised 182 women with breast cancer undergoing chemotherapy to scalp cooling (n = 119) or control (n = 63). Scalp cooling was done 30 minutes prior to and during and 90 minutes after each chemotherapy infusion. Hair preservation was assessed at the end of 4 cycles of chemotherapy. One interim analysis was planned to allow the study to stop early for efficacy.
At the time of the interim analysis, 142 participants were evaluable. The researchers found that patients who received scalp cooling were significantly more likely than patients who did not receive scalp cooling to have less than 50% hair loss, with 51% of those in the scalp cooling group retaining their hair, compared with 0% of those in the control group.
There were no significant differences in changes in any of the measures of quality of life between the groups. A total of 54 adverse events were reported in the cooling group, none of which were serious.
In another study, Hope S. Rugo, MD, University of California, San Francisco, California, and colleagues included 122 women with breast cancer receiving chemotherapy (106 in the scalp cooling group and 16 in the control group). Scalp cooling was initiated 30 minutes prior to each chemotherapy cycle, with scalp temperature maintained at 3 degrees Celsius throughout chemotherapy and for 90 minutes to 120 minutes afterward.
Among the 122 patients in the study, the average duration of chemotherapy was 2.3 months. Hair loss of 50% or less was seen in 67 of 101 patients (66%) evaluable for alopecia in the scalp cooling group versus 0 of 16 patients (0%) in the control group.
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% reported feeling less physically attractive compared with 56% of patients in the control group. 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.
"Further research is needed to assess outcomes after patients receive anthracycline regimens, longer-term measures of alopecia, and adverse effects," the authors wrote.