Scalp cooling devices are designed to prevent chemotherapy-associate hair loss (alopecia). Scalp cooling works by reducing blood flow to hair roots, thereby lowering the exposure of hair follicles to chemotherapy. Scalp cooling has been used routinely in Europe for more than a decade; the first device (Dignicap) was approved in the U.S. in 2015. Scalp cooling appears to be oncologically safe; it has not been linked to increased metastasis to the scalp. Now a new U.S. study has reported that scalp cooling is effective in two-thirds of cases among women treated with non-anthracycline chemotherapy regimens for early-stage breast cancer.

Hair loss is one of the most disturbing side effects of chemotherapy. In most cases, it is temporary, however hair can sometimes grow back with a different color and texture, often grayer, coarser and curlier. Taxane chemotherapy (especially Taxotere) can cause permanent hair loss in a small fraction of cases. Scalp cooling has been reported to prevent hair loss requiring the use of wigs or hair coverings in 40% to 80% of cases. Its effectiveness depends on the type and duration of chemotherapy, as well as the timing, duration and temperature of the cooling and the fit of the cap.

Latest research finds scalp cooling effective in reducing hair loss

The study referenced at the beginning of this news story was designed to examine the effectiveness of a scalp cooling system among breast cancer patients receiving certain types of chemotherapy regimens, and to evaluate the impact of scalp cooling on quality of life. The study included women with stage I or II breast cancer treated at five U.S. medical centers between August 2013 and October 2014. Women who were treated with both an anthracycline and a taxane (either sequentially or in combination) were excluded from the study. In fact, none of the women in the scalp cooling group received an anthracycline such as Adriamycin, which means that the study was in effect a test of scalp cooling in those administered taxanes such as Taxol or Taxotere. A total of 106 patients were in the scalp cooling group and 16 were in the control group, of whom 77% were white, 9% were black, and 11% were Asian. The average duration of chemotherapy was 2.3 months. Average age was 53 years (range: 28-77 years). Median follow-up was 29.5 months.

Scalp cooling was initiated 30 minutes before each chemotherapy treatment, maintained throughout chemotherapy, then continued for an additional 90 to 120 minutes. Scalp temperature was kept at approximately 3C (37F). The Dean scale (Poor = 75-100% hair loss, Moderate = 50-75% loss, Good = 25-50% loss, Excellent = 0-25% loss) was used to assess hair loss. The treatment was considered a success if hair loss was under 50%. Quality of life was assessed at baseline, at the beginning of the final chemotherapy cycle, and one month later.

Hair loss was self-assessed four weeks after the final dose of chemotherapy by patient review of five photographs. A total of 67 of the 101 women in the scalp cooling group experienced hair loss of less than 50%, whereas all of the control group experienced at least 50% hair loss. Three of five quality-of-life measures were significantly better one month after the completion of chemotherapy in the scalp cooling group. For example, 27% of the scalp cooling group reported feeling less physically attractive compared to 56% of the control group. Four of the women in the scalp cooling group experienced mild headaches and three discontinued it due to feeling cold. The authors conclude that, among women undergoing non-anthracycline-based adjuvant chemotherapy for early-stage breast cancer, the use of scalp cooling was associated with significantly less hair loss than no scalp cooling. The authors comment that additional research is needed to evaluate patients who receive anthracycline regimens, longer-term measures of hair loss, and adverse effects.