Scalp cooling system to prevent alopecia: Effectiveness, psychological effects and feasibility

Background: In order to counter the alopeciatic effect of some chemotherapies (CT), oncology centres have started using scalp-cooling devices.Recent literature demonstrates considerable interest in investigating its real effectiveness, the reasons for dropouts, and the effects on the emotional states and on patients’s quality of life (M.G.S. Salvo, 2010). This study aims to assess the efficacy of scalp- cooling devices in preventing CT – induced alopecia. Secondary outcomes: i) the feasibility of scalp cooling introduction in terms of timing and of resources involved; ii) to investigate change of psychological distress and health-related quality of life in scalp cooling treatment. Material and Methods: This prospective no-profit study was conducted from March 2016 to July 2018. (approved by Ethical Commitee: N.43/2015). Inclusion criteria: women with different types of oncological pathology, no alopecia, age ≥18 years and ECOG performance status 0–1, who were scheduled to alopecic CT. Exclusion criteria: alopecia pre-CT, history of treatment with CT and contraindications due to other diseases. Hair loss (HL) was evaluated by patient self-assessment and by the physician according to the Dean’s scale at half and at end of treatment. A Dean’s scale score of 0–1 (i.e. HL ≤ 50%) was considered a success. Patients completed questionnaires (TD, HADS, QLQ-30 e BR-23) before, at half and at end of CT. 47 women, (mean age 55 ± 11) of whom 62% with breast disease, adhered to the study. 79% completed scalp-cooling treatment, while 21% discontinued after half-treatment. Results: Scalp cooling was effective in preventing CT-induced HL in 35 of 37 patients (94.6%) who concluded treatment. With carbo-taxol scheme, initial loss was followed by stabilization and thickening during the second half of chemotherapy. There was a fair agreement between patients and staff evaluation on HL (weighted Cohen’s Kappa = 0.27). Long refrigeration times determine the need for health workers to be present on two shifts. We found statistically and clinically significant improvement in the emotional state (distress, social role, cognitive functions, and pain) at mid-treatment with results stabilized till the end of CT. In patients with psychological support, this improvement was achieved during the whole treatment. Conclusions: The study showed very positive results as regards the effectiveness of the scalp-cooling and a tipical trend of alopecia with carbotaxol. Patients overestimate HL respect to operators’ evaluations: it could be useful to carry out psychoeducation and information activities. To set up the scalp-cooling procedure in a stable way is necessary that the structures must be organized for full time opening. The results on emotional dimensions prove the importance to plan psychological support actions, halfway through the CT pathways. No conflict of interest.