Oncology
patients, leading to more positive attitudes to treatment. In order for the study to effectively and
consistently evaluate the efficacy of scalp cooling, it used two primary criteria: firstly, patient-reported head covering usage during the final chemotherapy session and secondly, WHO alopecia scores. Head covering usage, whether a wig or scarf, is commonly used as an important outcome measure of efficacy, representing patient satisfaction with the treatment. Additionally, the WHO alopecia score, ranging from 0 (no alopecia) to 3 (total alopecia), was used to gauge the extent of hair retention. In some cases, despite a higher WHO
alopecia score, the absence of a head covering indicated successful treatment, highlighting the subjective nature of patient satisfaction.
Key findings and results The analysis of the 13-years’ worth of scalp cooling data yielded significant findings on the overall efficacy of scalp cooling that present significant evidence on efficacy. l Overall Efficacy: 56% of patients did not require a head covering at the start of their final chemotherapy session, indicating satisfactory hair retention.
l WHO Scores: 53% of patients reported minimal hair loss, with WHO scores of 0 or 1.
l Chemotherapy Regimen: The study confirmed that the type of chemotherapy regimen was the only significant determinant of scalp cooling efficacy within its scope.
The study found that other factors, such as patient demographics, lifestyle habits (e.g., smoking and drinking), age, hair type, cancer type and gender, did not significantly influence scalp cooling outcomes. For instance, gender did not play a significant role in the success or tolerability of scalp cooling, nor in the likelihood of prematurely discontinuing the treatment. This finding supports the equal efficacy of scalp cooling for both male and female patients, underlining the importance of offering scalp cooling to all eligible patients.
Taxanes vs. anthracyclines and other challenging regimens The studies confirmed that patients can anticipate a higher likelihood of hair retention when prescribed a taxane-based chemotherapy regimen. Overall, patients receiving taxanes had better results (78%) compared to patients receiving anthracyclines (40%) or a combination regimen involving anthracyclines (45%) as well as other more challenging regimens such as Irinotecan (36.5%).
While the data suggests more
favourable results for taxanes, this data should be used to help clinicians set expectations for their patients, rather than dissuade them from accepting chemotherapy regimens that are less receptive to scalp cooling treatments. Even if retention may be challenging, patients should still be offered the opportunity to try scalp cooling. The study did not explore the well-researched
principle of follicle protection that scalp cooling provides against high cumulative dosages of taxane drugs.1
Alongside hair retention,
evaluated in this particular study, follicle protection also encourages faster regrowth and helps to prevent persistent chemotherapy- induced alopecia, as evidenced through studies elsewhere in the world.
Differences in results between cohorts It is worth noting that differences in the results seen in the three cohorts from the study could be attributed not only to chemotherapy regimen, but also to the size of the cohort and the increased awareness of scalp cooling protocols and usage. Dutch clinical staff from cohorts 2 and 3 may have already had years of experience with scalp cooling, leading to optimised cap fits and more accurate cooling times. In the 2024 manuscript by Brook et al, machine learning algorithms were used in the 3rd cohort study to identify extraneous variables which may have led to overfitting.
Cohort 1 is 28%, the size of cohort 2. Smaller cohorts can provide less information and context on efficacy. For example, patients
Conclusions and implications for practice The updated findings have important implications for clinical practice, affirming that scalp cooling is effective for the majority of patients, with no immediate need for changes in current standard practices. Notably, the study highlights the gender equality in scalp cooling efficacy, demonstrating that both male and female patients benefit equally, having investigated non-gender specific cancers and analysing the data separately from those such as cancer of the prostate or breast. As a result, it is recommended that scalp cooling should be routinely offered to male patients as well if they are eligible, in addition to being as informed as female patients. 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
May 2025 I
www.clinicalservicesjournal.com 57
receiving Vinorelbine (Vino) in cohort 1 displayed zero usage of a head covering whereas cohort 2, 22% of patients felt the need to cover their head. While every patient is different, only 5 patients received Vino in the first study –
a small sample size. In the second cohort, there were 34 patients studied that received the same drug. A larger n number gives a clearer picture of the efficacy of and patient experience with Vino, which is another reason why the Registry is so valuable to clinicians.
t
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60
