Scalp hypothermia seems to be effective in minimizing alopecia in some women with breast cancer who develop the condition as a result of their chemotherapy regimen, according to the results of a pilot study.
"Alopecia, though temporary, is one of the most distressing side effects of chemotherapy in breast cancer patients," said Shannon Wills, PhD, clinical research associate at Beaumont Hospitals in Royal Oak, Michigan. "In fact, up to 8% of women reportedly refuse chemotherapy because of the potential for this side effect."
She added, women who refuse chemotherapy and "go with" just surgery and radiation increase their risk of recurrent disease, because systemic chemotherapy is sometimes necessary to prevent recurrence.
Several scalp-cooling techniques have been tried, including ice packs consisting of crushed ice, but results have been mixed, she said.
The technique used in the trial involves the continuous application of a cold cap to the scalp before, during, and after chemotherapy. The method is thought to work via cutaneous vasoconstriction, which decreases blood flow to the hair follicles during chemotherapy and thus reduces the cellular uptake of chemotherapeutic agents.
Wills and colleagues reported data using a cold cap in 34 women with stage I to III breast cancer who were receiving standard adjuvant chemotherapy regimens with or without doxorubicin.
Participants in the trial had agreed to wash their hair no more than two times per week during chemotherapy and for 4 months after the completion of chemotherapy. They were instructed to use a mild shampoo and tepid water. The use of hair color as well as hot rollers, curling irons, and hot air blow dryers was not permitted.
Caps were typically cooled and maintained between -5°C and -15°C for 24 hours prior to the start of chemotherapy. Two caps were worn for 20 minutes each before the infusion to initiate the scalpcooling process. Afterwards, caps were changed every 30 minutes throughout chemotherapy and for an additional 3 hours after chemotherapy.
Patients were monitored throughout the cooling process for hyperpigmentation of the scalp, headache, and intolerance to cold temperature.
Chemotherapy regimens used in the trial were regimens commonly used in breast cancer patients, all of which nearly always cause alopecia. Regimens included doxorubicin/cyclophosphamide for four cycles; dose-dense, doxorubicin/ cyclophosphamide followed by paclitaxel for eight cycles; docetaxel/doxorubicin/cyclophosphamide for six cycles; docetaxel/cyclophosphamide for four cycles; and docetaxel/carboplatin/trastuzumab for six cycles. Overall, 22 patients received an anthracycline-based regimen, and 12 patients received a nonanthracycline-based regimen.
A validated assessment tool known as Dean's scale was used for alopecia grading.
Overall, alopecia was significantly more likely to occur in women who got an anthracycline-based regimen. Also, 83% of women in the nonanthracycline-containing group and 47% of women in the anthracycline-containing group felt that they did not need either a wig or scarf. Hair thinning for most patients in both groups was even and not patchy.
Treatment was well tolerated in most cases. Overall, three patients dropped out of the study because of either scalp discoloration during treatment or discomfort related to cooling.
"What's particularly gratifying for practitioners is that the treatment, by allowing patients to retain their hair, gave patients a sense of being normal when their life was not normal," Wills pointed out.
"It's important to keep in mind that concern about alopecia is not really a question of vanity," she added. "You're going through all of this, you've been told you may lose your breast, you have surgery, and by the time you're almost done, your physician now tells you that you may need chemotherapy and that you'll lose your hair. The prospect of hair loss is like the last jab."