Oncology
Strengthening the case for scalp cooling
Data from a registry spanning 13 years has provided new insights into scalp cooling to treat chemotherapy-induced alopecia. Toni Brook and Daniel Milner provide an overview of the key findings and implications for practice.
For decades, chemotherapy-induced alopecia (CIA) has remained one of the most visible and distressing side effects of cancer treatment. Managing the psychological and emotional tolls of cancer is just as critical as managing the physical ones. Hair loss can severely impact a patient’s identity, privacy and confidence, making strategies for managing this side-effect crucial. The psychological impact caused by CIA can also extend to families, causing emotional distress for everyone including young children, who see evident physical changes to their loved one. Scalp cooling has long been the only
scientifically validated method of reducing chemotherapy hair loss. In the UK, the Paxman mechanised scalp cooling system is present in 99% of NHS and private hospitals. However, access to this treatment is still inconsistent across cancer centres in other parts of the world. In an unprecedented study – the Dutch
Scalp Cooling Registry – the case for scalp cooling in prevention of chemotherapy- induced alopecia is stronger than ever. Spanning 13 years, the registry documents the experiences of 7,424 patients who underwent mechanised scalp cooling across 68 hospitals. By examining patient outcomes across 24 different chemotherapy regimens, the study provides valuable insights into the factors that affect the efficacy of scalp cooling to mitigate chemotherapy-induced alopecia (CIA). The results show a 56% success rate across
the 7,424 patients, along with averages for specific chemotherapy regimens, indicating a higher success rate with taxanes. The results also offer insights into whether gender, cancer type, lifestyle choices, chemotherapy naivety or other factors play a role in outcomes. This Registry, the largest of its kind globally, serves as a crucial resource for clinicians delivering scalp cooling as a means of managing chemotherapy-induced hair loss. The efficacy of scalp cooling in delivering favourable results can no longer be denied.
A landmark study This new scalp cooling registry, by Dr. Corina van den Hurk et al, represents the most comprehensive real-world investigation into scalp cooling. Conducted between 2006 and 2019, and published in The Oncologist, the study collected data on patient demographics, chemotherapy protocols, hair characteristics and treatment experiences. It offers the largest-ever data set for scalp cooling research, underscoring its importance as a cornerstone of supportive cancer care. “This is the first time that the patient
experience of scalp cooling has been documented on this scale and advocates the importance of the patient perspective for chemotherapy-induced side effect management,” says PhD, co-author and Senior Researcher at the Catharina Hospital, Eindhoven
The publication of the Registry data represents a milestone in clinical scalp cooling research. By analysing the findings from such a large patient cohort, the great statistical power of the study provides the strongest ever evidence for the efficacy of scalp cooling in protecting cancer
patients from chemotherapy-induced hair loss. Nik Georgopoulos, Associate Professor at Sheffield Hallam, Biomolecular Sciences Research Centre (BMRC)
Proven biological mechanisms of scalp cooling Before taking a deep dive into the study and its results, it’s important for those unfamiliar with how scalp cooling works to appreciate the multiple mechanisms at play when chemotherapy patients put on the cold cap. Scalp cooling helps prevent CIA by lowering
the temperature of the scalp and limiting the exposure of chemotherapy drugs. Despite its long-standing use, questions around mechanisms and efficacy remain among oncology professionals. However, through extensive research, it has been determined that a number of mechanisms of scalp cooling, when occurring in combination, render cooling of the scalp cytoprotective.1
This contributes
to reported clinical efficacy when used in conjunction with chemotherapy treatment for solid tumour cancers.
Vasoconstriction Firstly, vasoconstriction in the scalp occurs as the cold cap reduces the temperature below the skin’s normal levels. The vasoconstriction results in a reduction of blood flow to between 20-40% of normal blood flow levels thereby reducing the extent of drug exposure to the hair follicles.
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