Oncology
Reduced drug uptake Secondly, active transport via membrane proteins, as well as passive diffusion, are the processes by which chemotherapy drugs (such as the anthracycline doxorubicin) enter the cell via the cell membrane. As demonstrated through biological studies using cell cultures, when the scalp is exposed to the colder temperatures of the cold cap, this results in reduced drug uptake across the plasma membrane of hair follicle cells. The cellular activity of the hair follicles is lower as is the kinetic energy and membrane fluidity. Low temperatures can cause structural changes to the plasma membrane, and this can dramatically reduce its permeability for chemotherapy drugs.
Reduced hair follicle cell division Chemotherapy drugs are notorious for being unable to distinguish rapidly dividing healthy cells from the cancerous ones. This includes hair follicles, where during the active phase growth, the cells in the follicles, continually stimulated by growth factors, are in a highly proliferative state. As a consequence, these cells are more vulnerable to the cytotoxic effect of chemotherapy drugs. Scalp cooling reduces the metabolic activity
of hair follicle cells, slowing down the cell division, rendering them less susceptible to chemotherapy drugs.
Reduced metabolic activity Finally, the myriad of biological reactions that take place inside cells, such as metabolism, cell growth and cell death, is catalysed by enzymes - which are acutely temperature-dependent. A reduction in temperature may thus cause deceleration
The type of chemotherapy regimen remains the most critical determinant of scalp cooling success, with patients receiving taxanes seeing the best outcomes. However, the study also emphasises the need for further research into the unknown determinants that lead to varying outcomes among patients on the same chemotherapy regimen.
of cellular processes that can be involved in chemotherapy drug-mediated cytotoxicity. The deceleration of these processes could help attenuate toxicity and hair follicle damage. Along with these proven methods, the
Registry addresses ongoing doubts around efficacy with robust data, affirming scalp cooling as an essential intervention for hair preservation. Key to the study’s success was its inclusivity, ensuring that a wider range of patients as possible, including both men and women, were assessed to build an even stronger case for scalp cooling.
The Registry’s methods and data collection
All patients eligible for scalp cooling during the study were invited to participate, regardless of whether they had received treatment for CIA before. The Registry’s depth is unprecedented and collected comprehensive data from both nurses and patients through questionnaires, covering a wide range of variables to thoroughly
understand the determinants of scalp cooling success. The variables assessed included:
l Demographics: Age, gender, cancer type, and treatment setting.
l Chemotherapy Details: Regimens, doses, and infusion times.
l Medical Background: Presence of liver metastases, previous chemotherapy, previous hair loss, or prior scalp cooling.
l Hair Characteristics: Hair length, density, ethnic hair type, and any prior chemical manipulation.
l Scalp Cooling Protocols: Pre- and post- infusion cooling times, hair dampening practices, and treatment tolerability.
“Sharing data enhances both patient outcomes and the overall quality of care. By collaborating, you can gather sufficient data more rapidly, allowing for reliable conclusions about effectiveness and the identification of best practices,” comments Corina van den Hurk, PhD, co-author and Senior Researcher at Santeon hospitals. The Registry also collected additional information from 2013-2019, such as anthropometric characteristics (height and weight), lifestyle tendencies, pre-treatment greying, natural shedding patterns, hair colour, potential technical issues with the scalp cooling machine, and patient satisfaction with the scalp cooling process.
Evaluation criteria The Scalp Cooling Registry was focused on efficacy, so what did the authors of the study use to determine if scalp cooling was effective? Hair loss and its extent can be a very subjective topic – what may seem like a failure to one patient is a huge success for another - the authors knew they would somehow need to quantify this into useful datasets. In addition to its primary objective, the published Registry results mean that expectations can now be better managed for
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www.clinicalservicesjournal.com I May 2025
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