Effect of Scalp Cooling on Hair Loss in Women Receiving Nonanthracycline Chemotherapy for Breast Cancer


Key Points

  • In women receiving nonanthracycline chemotherapy for early-stage breast cancer, scalp cooling was associated with a significant reduction in hair loss of 50% or more.
  • Scalp cooling was associated with improved quality-of-life measures.

In a prospective cohort study reported in JAMA, Rugo et al found that use of a scalp-cooling device reduced hair loss in women receiving nonanthracycline chemotherapy for early-stage breast cancer.

Study Details

In the study, 101 evaluable patients from 5 U.S. centers with stage I or II breast cancer receiving adjuvant or neoadjuvant chemotherapy regimens underwent scalp cooling with a cap device beginning 30 minutes prior to and continuing until 90 to 120 minutes after chemotherapy administration. A concurrent age- and chemotherapy treatment–matched control group of 16 patients was included. The study was performed between August 2013 and October 2014.

The primary outcome measure was self-estimated hair loss using the Dean scale at 4 weeks after the last dose of chemotherapy, with a score of 0 to 2 (≤ 50% hair loss) being defined as treatment success. Quality of life was assessed at baseline, at the start of the last chemotherapy cycle, and 1 month later using 5 measures from the European Organisation for Research and Treatment of Cancer Breast Cancer–Specific Quality-of-Life Questionnaire.

Among all patients, the mean age was 53 years (range = 28–77 years), and 77.0% were white, 9.0% were black, and 10.7% were Asian. No patients in the scalp-cooling group received anthracyclines. The most common chemotherapy regimen was docetaxel and cyclophosphamide for 4 to 6 cycles (75%), with other regimens including docetaxel and carboplatin (12.8%), weekly paclitaxel (11.9%), and docetaxel (1%). The median duration of chemotherapy was 2.1 months.

Hair Loss Outcomes

Hair loss of 50% or less was observed in 67 of 101 patients (66.3%, 95% confidence interval = 56.2%–75.4%) vs 0 of 16 patients in the control group (P < .001). In the scalp-cooling group, maximum Dean score was 0 in 5.0% of patients, 1 (> 0% to ≤ 25% hair loss) in 30.7%, and 2 in 30.7%. A post hoc analysis by an independent panel performed before all patients had reached the 1-month evaluation indicated hair loss of 50% or less in 74 of 88 patients (84.1%) evaluated.

Quality of Life and Adverse Events

Patients in the scalp-cooling group had significantly better outcome on 3 of the 5 quality-of-life measures: 27.3% vs 56.3% reported feeling less physically attractive (P = .02); 32.4% vs 60.0% reported being quite or very upset by hair loss (P = .04); and 15.9% vs 37.5% reported being quite or very dissatisfied with their body (P = .04).

On the Patient Symptom Survey 0 (best) to 100 (worst) scale, chilliness was reported by 98% of the scalp-cooling group, with a mean score of 49.5; headache was reported by 41%, with a mean pain level of 39.3; and scalp pain was reported by 71%, with a mean pain level of 24.2. Mild headache was reported as an adverse event in 3.8% of patients. Scalp cooling was discontinued in 2.8% of patients due to feeling cold.

The investigators concluded: “Among women undergoing non-anthracycline-based adjuvant chemotherapy for early-stage breast cancer, the use of scalp cooling vs no scalp cooling was associated with less hair loss at 4 weeks after the last dose of chemotherapy. Further research is needed to assess outcomes after patients receive anthracycline regimens, longer-term measures of alopecia, and adverse effects.”

The study was funded by Dignitana AB, the Lazlo Tauber Family Foundation, the Anne Moore Breast Cancer Research Fund, and the Friedman Family Foundation.

Hope S. Rugo, MD, of the Helen Diller Family Comprehensive Cancer Center, is the corresponding author of the JAMA article.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.