Breast Cancer Research Centre - WA

Should all women recommended to have chemotherapy be advised to use a “cold cap”?

Should all women recommended to have chemotherapy be advised to use a “cold cap”?

Chemotherapy-induced alopecia (CIA) or hair loss is one of the most commonly occurring and distressing side effect of breast cancer treatment.

Studies indicate that even with the knowledge of temporary hair loss, more than half of respondents describe this symptom as being burdensome, as well as an outward sign of cancer associated with negative self-image and feelings of depression and anxiety.

Although CIA is almost always reversible after chemotherapy, current options to prevent CIA from occurring are limited.

Scalp cooling (SC – a device which women wear on their heads during chemotherapy) to reduce the degree of CIA has been utilised for over 40 years. Studies have shown it to be safe (i.e. using SC is not associated with higher rates of breast cancer recurrence) and is currently the most effective technique in reducing CIA when compared with no scalp cooling.

Despite consensus in the literature that scalp cooling is effective, several variables have been suggested to influence its success. These include hair thickness, type and dose of chemotherapy treatment, scalp temperature that can be achieved with the device and cap fitting technique.

It has been suggested that lowering the scalp subcutaneous tissue to 22 C is necessary to prevent alopecia, with laboratory studies, suggesting that temperatures of 14 C – 18 C may be even more effective

The study that we did at BCRC-WA was to see how effective SC is when women are recommended different types of chemotherapy, in an effort to inform future patients as to whether they should use SC or not. Further we explored whether the degree of success in minimising the amount of hairloss, could positively impact on mood and body image. Finally, we tested whether lowering the SC temperature beyond the usual setting of 5oC could lead to greater effectiveness.

Our study results confirm that women recommended to have a particular type of chemotherapy (viz. anthracyclines) have high rates of hair loss and many patients did not persevere with using SC. Patients who receive another type of chemotherapy called taxanes, experienced the highest rates of minimal hair loss and all patients in this group used the SC for all cycles of their chemotherapy, which also reflects the good tolerability of the device.

Although our study did not show having minimal hair loss was associated with with improved mood and body image, we would routinely recommend the use of SC to women being recommended for taxane-based chemotherapy. For patients who are to receive anthracycline-based chemotherapy, an individualised approach should be taken, balancing the low rates of effectiveness and longer treatment times against the importance of hair loss perceived by the patient. Lowering the scalp temperature did not appear to be more effective, so 5oC remains the recommended temperature setting. We continue to monitor all patients that entered the trial to ensure that scalp metastases do not occur at a higher than expected incidence.

The complete findings of our study can be found here.

We would like to acknowledge the donation of the Digitana Scalp cooling device by Ashley and Martin.

Prof. Arlene Chan
Medical Oncologist
MB BS, FRACP, MMed (Palliative Care)