Assessment of scalp cooling to prevent chemotherapy-induced alopecia using standard infusion room documentation and patient surveys.

Abstract

e24106 Background: Chemotherapy induced alopecia (CIA) is one of the most distressing reported side-effects of cancer treatment, with patients (pts) reporting negative impacts on self-image and quality of life. Scalp cooling (SC) devices can prevent CIA. SC efficacy varies by chemotherapy regimen and dose, and taxane-based therapies report better outcomes. Here we report the efficacy of SC with the Paxman SC system using a standard infusion room nursing assessment and patient surveys. Methods: Pts using SC at the MGH Cancer Center between 4/2018 and 12/2019 were included in the analysis. Routine infusion room nursing assessments included CTCAE 4.0 grading for alopecia. A retrospective review of SC pts with documented CTCAE grades was conducted with success defined as grade (Gr) 0 or 1 alopecia at the final infusion. CTCAE results were compared to patient surveys of self-assessed success. Additional data include disease type, regimen and SC discontinuation details. Results: 64 pts who initiated SC and had CTCAE grade recorded were included. The most common chemotherapy regimens were docetaxel/cyclophosphamide (33%), docetaxel/carboplatin/trastuzumab/pertuzumab (19%), paclitaxel/trastuzumab (16%) and paclitaxel weekly/pertuzumab/trastuzumab (6%). Breast cancer was the most common disease type (92%). 77% of pts had successful hair retention (Gr 0 = 23 (36%), Gr 1 = 26 (41%)). 3 pts received anthracycline-based therapy and 1 successfully retained hair. Among 11 pts who completed post-treatment surveys, patient reported outcome and CTCAE were concordant in 9 (82%) pts. 13 (20%) pts terminated SC early; 9 (69%) after 2 treatments (tx), 2 (15%) after 3 tx, 1 (8%) after one tx and 1 (8%) after 5 tx. The most common reason for early dc was extent of alopecia (10, 77%). Other factors in the decision were time and discomfort. Of the 51 pts who completed SC for the entire chemotherapy tx, 48 (94%) received a taxane-based regimen and 46 (90%) had successful hair retention. Conclusions: In this single institution experience, we observed a high success rate of scalp cooling to prevent chemotherapy induced alopecia in a population of mostly breast cancer patients receiving taxane-based regimens. Concordance between patient reported outcome of success and routine standard of care nursing CTCAE documentation in the electronic medical record provides a simple and accurate method to monitor outcomes with scalp cooling. Despite high success, 20% discontinued SC, suggesting further studies to improve outcomes and tolerability are needed.