open access: Factors Influencing the Effectiveness of Scalp Cooling in the Prevention of Chemotherapy-Induced Alopecia

open access

Introduction. The success of scalp cooling in preventing or reducing chemotherapy-induced alopecia (CIA) is highly variable between patients and chemotherapy regimens. The outcome of hair preservation is often unpredictable and depends on various factors.

Methods. We performed a structured search of literature published from 1970 to February 2012 for articles that reported on factors influencing the effectiveness of scalp cooling to prevent CIA in patients with cancer.

Results. The literature search identified 192 reports, of which 32 studies were considered relevant. Randomized studies on scalp cooling are scarce and there is little information on the determinants of the result. The effectiveness of scalp cooling for hair preservation depends on dose and type of chemotherapy, with less favorable results at higher doses. Temperature seems to be an important determinant. Various studies suggest that a subcutaneous scalp temperature less than 22°C is required for hair preservation.

Conclusions. The effectiveness of scalp cooling for hair preservation varies by chemotherapy type and dose, and probably by the degree and duration of cooling.

Implications for Practice: Despite the continuous development of cytotoxics and new targeted therapies, chemotherapy induced
alopecia (CIA) remains a major problem. The ongoing underestimation by medical professionals of the high impact of CIA
for patients and their relatives has resolved in minimal efforts to prevent CIA. The literature is mainly restricted to patient series
evaluating the effectiveness. Future research should focus on determinants of the result, in particular, scalp cooling temperature
and time. Reviews on scalp cooling clearly show that scalp cooling is an effective method to prevent CIA. Scalp cooling should therefore
be available in every hospital and health care professionals should offer the possibility of scalp cooling to all eligible patients

Table 1. Cytotoxic drugs that cause chemotherapy-induced
alopecia

Severe alopecia (selected from Table 1)

(>10% of patients)

Busulfan

Docetaxel

Doxorubicin

Etoposide

Gemcitabine

Idarubicin

Ifosfamide

Irinotecan

Mitomycin

Oxaliplatin

Paclitaxel

Topotecan

Vinorelbine

Procarbazine