Chemotherapy-induced Alopecia Research Articles

Scalp cooling to reduce alopecia as a barrier to chemotherapy.

e12537 Background: Chemotherapy induced alopecia (CIA) is one of the most distressing adverse events reported by patients undergoing chemotherapy, yet there is limited data addressing the impact of CIA on treatment acceptance. Scalp cooling (SC) has been shown to decrease CIA. Here we report our assessment of CIA as a barrier to chemotherapy and the efficacy of SC using pre- and post-treatment surveys of patient reported outcomes. Methods: Patients who received alopecia-inducing chemotherapy and utilized SC between November 2018 and September 2020 at our institution were enrolled in a prospective IRB approved registry. Surveys including the Chemotherapy Induced Alopecia Distress Scale (CADS) were administered before and within two weeks after treatment. Using the CADS survey, patients were asked about their hesitation to receive chemotherapy and the burden they feel about alopecia as a side effect of chemotherapy. Results: Of 90 patients who completed the first or last treatment survey, the most common treatment regimens were docetaxel/cyclophosphamide (TC), docetaxel/carboplatin/trastuzumab/ pertuzumab (TCHP), and paclitaxel/trastuzumab (TH). The most common disease type was breast cancer (92.2%) and all participants were females. Of 74 SC patients who completed the pre-treatment survey, the median age was 50.5 (range 26-75) and included 65 (87.8%) Caucasian, 4 (5.4%) Black, and 3 (4.0%) Asian patients. 89.2% used Paxman SC and 10.8% used Penguin SC. Of those who completed the CADS survey prior to treatment, 8 (10.8%) reported ‘quite a bit’ to ‘very high’ hesitation, and 34 (46.0%) reported feeling that alopecia was either ‘quite’ or ‘very much’ a burden of chemotherapy. All 40 SC patients (median age 53.5, range 31-76) who completed the post-treatment survey were Caucasian and used Paxman SC. Self-reported efficacy of SC in these 40 patients was less than 10% hair loss in 10 (25.0%), 11-25% hair loss in 7 (17.5%), 26-50% hair loss in10 (25.0%), 51-75% hair loss in 9 (22.5%), and 76-100% hair loss in 4 (10%). Overall, 27 (67.5%) patients reported SC limited alopecia ‘a lot’ to ‘perfectly’. Conclusions: In our study, alopecia was identified as a notable burden to nearly half our SC patients and 10.8% hesitated when making their decision to receive chemotherapy. After using SC during treatment, 67.5% of patients reported less than 50% hair loss, and 67.5% reported that SC reduced alopecia ‘a lot’ or ‘perfectly’. Our study highlights the significance of alopecia as a chemotherapy burden and potential barrier to accepting treatment, and suggests SC may be efficacious in decreasing CIA, which may allow patients to feel less hesitation towards chemotherapy.

Randomized study of electric hand warmer (EHW) versus observation to avoid discomfort during scalp cooling for chemotherapy-induced alopecia (CIA) prevention.

12108 Background: CIA has been reported as the most disturbing adverse event of cancer treatment by most women receiving chemotherapy. Many strategies have been tested to minimize CIA, among which scalp cooling has proven high effectiveness. However, discontinuation rates of this technology vary from 3% to 13%, mostly due to headache, cold sensation and pain. EHW could be used to mitigate these side effects, produce heat on demand and a warming sensation. The primary objective of this study is to evaluated the impact of EHW device on the general comfort of breast cancer patients while on scalp cooling during chemotherapy treatment. Methods: Patients were randomly assigned to EHW use or observation. Thermal, sensory and general comfort were measured with pragmatic questionnaires after each chemotherapy infusion: neutral or hot as favorable thermal responses; comfortable and very comfortable as favorable sensory responses; finally, favorable outcomes in both thermal and sensory comfort questionnaires defined a positive result on the general comfort. We evaluated the impact of age (≤ or > 50 years), alopecia (grade 0 or 1/2), chemotherapy regimen (with or without taxanes) and EHW use (yes or no) in the different comfort scales using Logistic Regression (LR) models. Results: Forty women with early or locally advanced breast cancer were assigned to EHW (n = 20) or observation (n = 20) during neo(adjuvant) chemotherapy. Median age was 53 years, 67.5% concluded university education, 52.5% had comorbidities. Most patients had stage II disease (55%), largely ER/PR+ HER2- disease (67.5%), followed by triple negative (22.5%), and HER2+ (10%). Most frequent regimen was ACdd-Tdd (42.5%). Thirty-one patients (77.5%) continued scalp cooling during entire chemotherapy regimen (alopecia < grade 3). A favorable thermal response was seen in 79% of EHW applications as compared to 50% in control arm (odds ratio [OR] 3.79, P <.001). Sensory comfort was satisfactory in 82% of EHW applications as compared to 74% with control (OR 1.62, P =.1). General comfort was favorable in 73% of EHW applications as compared to 44% in control arm (OR 3.4, P <.001). Age, alopecia grade and taxane use did not significantly impact on comfort measures. Conclusions: Our study suggests that an EHW has a consistent favorable impact on thermal and general comfort of breast cancer patients under scalp cooling technology to prevent CIA. This simple device can improve patient´s quality of life and eventually avoid scalp cooling discontinuation due to discomfort.

558 Scalp cooling therapy for chemotherapy-induced alopecia including skin of color patients: A review of the literature

558 Scalp cooling therapy for chemotherapy-induced alopecia including skin of color patients: A review of the literature

The scalp cooling therapy for hair loss in breast cancer patients undergoing chemotherapy: a systematic review and meta-analysis.

To systematically assess the efficacy and side effects of scalp cooling in patients with breast cancer. A systematic literature search was conducted in October 2020 across Cochrane Library, PubMed, Embase, CINAHL, Web of Science, Scopus, and four Chinese databases (CNKI, Wanfang, SinoMed, and VIP database). Our review included all randomized controlled trials, cohort studies, and cross-sectional studies. Two authors independently searched databases, screened studies, extracted data, and evaluated each included study's methodological quality and risk bias. Meta-analysis was performed using Stata 15.1 software package and Revman 5.3 software, with estimates of scalp cooling effect and its side effects from pooled using a random-effects model. This study has been registered in the International Prospective Register of Systematic Reviews (PROSPERO, CRD42020216224). In total, 755 articles were screened and data from 27 studies involving 2202 participants were used in the meta-analysis. Studies meeting inclusion and exclusion criteria were three randomized clinical trials, 12 cohort studies, and 12 cross-sectional studies. The effectiveness rate of using a scalp cooling device to protect hair was 61% (95% CI: 55 to 67%, I2 = 88%, P = 0.000). However, scalp cooling therapy's side effects are not be ignored, such as headache, dizziness, scalp pain, neck pain, feeling cold, heaviness of the head, skin rash, nausea, and overtightened strap. This review shows that scalp cooling devices can significantly improve the patients with breast cancer chemotherapy-induced alopecia, but the implications of its side effects provide guide for the implementation of this technology.

ER71/ETV2 Promotes Hair Regeneration from Chemotherapeutic Drug-Induced Hair Loss by Enhancing Angiogenesis.

Chemotherapy-induced alopecia and hair loss can be stressful in patients with cancer. The hair grows back, but sometimes the hair tends to stay thin. Therefore, understanding mechanisms regulating hair regeneration may improve the management of chemotherapy-induced alopecia. Previous studies have revealed that chemotherapeutic agents induce a hair follicle vascular injury. As hair growth is associated with micro-vessel regeneration, we postulated that the stimulation of angiogenesis might enhance hair regeneration. In particular, mice treated with 5-fluorouracil (5-FU) showed delayed anagen initiation and reduced capillary density when compared with untreated controls, suggesting that the retardation of anagen initiation by 5-FU treatment may be attributed to the loss of perifollicular micro-vessels. We investigated whether the ETS transcription factor ETV2 (aka ER71), critical for vascular development and regeneration, can promote angiogenesis and hair regrowth in a 5-FU-induced alopecia mouse model. Tie2-Cre; Etv2 conditional knockout (CKO) mice, which lack Etv2 in endothelial cells, presented similar hair regrowth rates as the control mice after depilation. Following 5-FU treatment, Tie2-Cre; Etv2 CKO mice revealed a significant reduction in capillary density, anagen induction, and hair restoration when compared with controls. Mice receiving lentiviral Etv2 injection after 5-FU treatment showed significantly improved anagen induction and hair regrowth. Two-photon laser scanning microscopy revealed that enforced Etv2 expression restored normal vessel morphology after 5-FU mediated vessel injury. Our data suggest that vessel regeneration strategies may improve hair regrowth after chemotherapeutic treatment.

Preventive effect of edaravone ointment on cyclophosphamide-chemotherapy induced alopecia.

We evaluated the preventive effect of the antioxidant edaravone (EDR) on chemotherapy-induced alopecia (CIA) to improve quality of life in cancer patients. Hair loss was induced by intraperitoneally administering cyclophosphamide (CPA, 75 mg/kg) to rats, and topically applying EDR ointment (100 mg/day) once daily for 16 days (when hair loss starts) or 21 days (just before hair growth). The rats were divided into four groups: control group (without CPA or EDR), EDR 0% group (CPA + EDR 0%), EDR 3% group (CPA + EDR 3%), and EDR 30% group (CPA + EDR 30%). The prevention of CIA was evaluated by the hair coverage score (five levels from 0 to 4). Furthermore, we measured the size of the hair follicle area and the expression levels of insulin-like growth factor (IGF)-1 mRNA in dermal papilla cells. The EDR 3% and EDR 30% groups exhibited higher hair coverage scores than the EDR 0% group on day 16 and day 21. On day 16, the hair follicle area in the EDR 3% and EDR 30% groups was significantly larger than that in the EDR 0% group. Furthermore, IGF-1 expression levels in the EDR 3% group were significantly higher than those in the EDR 0% group. On day 21, no significant difference was observed in hair follicle area or IGF-1 mRNA levels among the groups. Our results show that EDR administration lessened hair loss due to CPA in a dose-independent manner above doses of 3%, suggesting potential applications beside chemotherapy.

Prevention of Chemotherapy-induced Alopecia: Experience of a Cancer Center in Romania

"Background: Chemotherapy still represents the backbone of systemic treatment for many solid tumors. Alopecia remains one of its most distressing side effects. Scalp cooling is an effective strategy to reduce the risk of alopecia induced by chemotherapy, therefore this study aimed to assess the efficiency of DigniCap scalp-cooling system in our center. Material&Methods: 113 patients diagnosed with solid tumors, who underwent chemotherapy using the DigniCap scalp-cooling system in our center between January 2018 - December 2020, were included in the study. Alopecia was evaluated by the physician according to Dean’s scale at baseline and after the last cycle of chemotherapy. The primary endpoint was to evaluate scalp-cooling efficiency defined by a Dean's scale score of 0–2 (hair loss ≤50%). Results: 78 (72.3%) out of the 113 patients who used scalp cooling presented hair loss of 50% or less, the majority were females (91.2%) and had a diagnosis of breast cancer (49.6%) or gynecological cancer (27.4%). The mean number of chemotherapy cycles using DigniCap was 4.82 cycles. Hair loss greater than 50% of the scalp surface was observed in 27.7% of patients, the highest grade of alopecia being observed for anthracycline-based chemotherapy. No serious adverse events were reported. Conclusion: The results of this study support the evidence existing so far in the literature. Among patients who underwent chemotherapy for various cancer types, the DigniCap System significantly prevented hair loss and we consider that it should be integrated in the supportive care of patients."

Permanent Alopecia in Breast Cancer Patients: Role of Taxanes and Endocrine Therapies.

Permanent chemotherapy-induced alopecia (PCIA) has been described following high-dose chemotherapy regimens for allogeneic bone marrow transplants; however, reports of PCIA in breast cancer patients are increasing. Many prior reports involve treatment with taxanes, but the role of endocrine therapies has not been well defined. Permanent alopecia in breast cancer patients appears to be a potential adverse effect of taxanes and endocrine therapies. Although the cytotoxic effects of taxanes may lead to permanent hair loss, the influence of endocrine therapies on the remaining follicles may affect the pattern of hair loss. Further characterization of these cases may elucidate risk factors for developing permanent alopecia, allowing for more appropriate risk stratification and counseling. We describe 3 patients with breast cancer who experienced PCIA following chemotherapy with taxanes.

Does Scalp Cooling Have the Same Efficacy in Black Patients Receiving Chemotherapy for Breast Cancer?

Despite U.S. Food and Drug Administration approval to reduce alopecia, data on efficacy of scalp cooling in Black patients with cancer are limited by lack of minority representation in prior clinical trials. Scalp cooling devices may have less efficacy in Black patients; additional studies are required to explore the possible causes for this, including hair texture and cap design. The Paxman scalp cooling (SC) device is U.S. Food and Drug Administration (FDA)-approved for prevention of chemotherapy-induced alopecia. Studies report 50%-80% success rates and high patient satisfaction, yet there have been no studies of SC in Black patients. We conducted a phase II feasibility study of Paxman SC with a planned enrollment of 30 Black patients receiving chemotherapy for stage I-III breast cancer. Black patients who planned to receive at least four cycles of chemotherapy with non-anthracycline (NAC) or anthracycline (AC) regimens were eligible. Alopecia was assessed by trained oncology providers using the modified Dean scale (MDS) prior to each chemotherapy session. Distress related to alopecia was measured by the Chemotherapy Alopecia Distress Scale (CADS). Fifteen patients enrolled in the intervention before the study was closed early because of lack of efficacy. Median MDS and CADS increased after SC, suggesting increased hair loss (p < .001) and alopecia distress (p = .04). Only one participant was successful in preventing significant hair loss; the majority stopped SC before chemotherapy completion because of grade 3 alopecia (>50% hair loss). SC may not be efficacious in preventing alopecia in Black women. Differences in hair thickness, hair volume, and limitations of cooling cap design are possible contributing factors.

Abstract PS9-20: Prospective observational study of chemotherapy-induced alopecia after sequential FEC+taxane and the effects of age in breast cancer patients

Abstract BACKGROUND: Chemotherapy-induced alopecia (CIA) is a common and quite distressing adverse effects of chemotherapy. CIA, which can occurr not only in the scalp but also in the eyebrows, eyelashes, and pubic hair, has been known to be a transient condition. However, the degree, pattern, phenotype and processes of CIA are not fully known. CIA might be influenced by many factors, such as the specific chemotherapy regimen, drug doses, the patient’s age, and hormonal statuses. There are few detailed observational studies of CIA or of the impact of age on CIA. We performed a prospective observational study to investigate the prevalence and degree of CIA, including CIA of eyebrows, eyelashes, and body, and we examined patient’s recovery from CIA, focusing on age-depending effects. METHODS: We analyzed 68 female Japanese patients with breast cancer (median age 53 years, range 29-76 yrs) who received perioperative adjuvant chemotherapy with fluorouracil/epirubicin/cyclophosphamide (FEC) and taxane. A questionnaire was administered at the point of chemotherapy completion and 6 and 12 months after chemotherapy completion. The data collected by the questionnaire were as follows: the degree of alopecia, including the eyebrows, eyelashes, and body (pubic, leg, and axillary hair), the onset of alopecia, the onset of hair regrowth, and changes in hair characteristics (color, texture, thickness, structure). RESULTS: CIA occurred in all patients, with severe hair loss irrespective of age. CIA occurred mainly in the scalp but also in the eyebrows, eyelashes, and body for most of the patients. There were significant associations between the patient’s age and the onset of hair regrowth in the eyebrows, eyelashes, and body. The onset of eyebrows, eyelash, and body hair growth were significantly shorter in the premenopausal patients. Any hair changes (e.g., thinned diameter, softer texture, curlier structure) were reported by 85.3% of the patients. The changes in hair diameter were significantly more often ‘thinner’ in the menopausal group compared to the premenopausal group, but the changes in texture, structure, and color were not significantly different between these groups. CONCLUSIONS: Our results revealed the clinical process of CIA in early breast cancer patients who received standard chemotherapy. Severe CIA occurred in all 68 patients who received FEC and taxane chemotherapy. The present findings provide the first data demonstrating that age was not associated with the degree or incidence of hair loss, but age affected the recovery from CIA. These findings are important for the provision of more accurate information to patients who may undergo chemotherapy, and our data will contribute to the optimal treatment for CIA. Citation Format: Takaaki Fujii, Kei Ichiba, Chikako Honda, Yuko Nakazawa, Misato Ogino, Sasagu Kurozumi, Sayaka Obayashi, Reina Yajima. Prospective observational study of chemotherapy-induced alopecia after sequential FEC+taxane and the effects of age in breast cancer patients [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS9-20.

Scalp cooling in breast cancer patients treated with docetaxel-cyclophosphamide: patient- and nurse-reported results.

Recent evidence supports the efficacy of scalp cooling in preventing chemotherapy-induced alopecia in breast cancer treatments. However, efficacy largely varies between treatment regimens. The aim of this study was to explore the patient- and nurse-reported results of scalp cooling in terms of hair loss and need for a wig/head cover in patients with breast cancer treated with 3-weekly docetaxel 75mg/m2-cyclophosphamide 600mg/m2. We studied nurse-reported efficacy as noted in the electronic patient files of 85 patients treated with docetaxel 75mg/m2-cyclophosphamide 600mg/m2 between 1/1/2017 and 1/1/2020. Sixty-nine of them also self-reported on their scalp cooling results up to one year after adjuvant chemotherapy in a retrospective way. Nurse- and patient-reported data showed that scalp cooling was successful (i.e., hair loss < 50%) in 47.1 and 44.9% of patients, respectively, and 55% of patients were (very) satisfied with the result of scalp cooling. Scalp cooling was perceived as (very) uncomfortable in 36.2% of patients. Regarding hair status one year after treatment, 47 patients (55.3%) reported no changes compared to their hair status before treatment. Scalp cooling is successful in preventing severe chemotherapy-induced alopecia in almost half of the patients with breast cancer treated with docetaxel 75mg/m2-cyclophosphamide 600mg/m2. Better understanding of the success rate of scalp cooling enables correct patient information and decision-making support.

Effects of improved hypoallergenic fabrics in medical wigs in patients with breast cancer with chemotherapy-induced alopecia: a randomised clinical trial

PurposeChemotherapy causes changes in appearance in patients with cancer. Therefore, to have a normal life, it is necessary for patients to wear a wig. However, wearing a wig may strain...

Which is More Difficult? Losing Hair or Losing Breast: A Qualitative Study

The study was conducted to determine how women with breast cancer perceive chemotherapy-induced alopecia. This qualitative study included 20 patients with chemotherapy-induced alopecia. The data were collected through the semi-structured interview method and analyzed using the "phenomenological analysis" method. Perceptions and experiences of women with breast cancer about chemotherapy-induced alopecia were examined under six themes; facing alopecia, perceiving alopecia, hiding alopecia, changes in life after alopecia, keeping hope alive, and facilitating the difficulties experienced. When women lost their hair, they experienced sadness, anxiety, panic, and regret. Most women shaved their hair and used accessories such as wigs, bandanas, and headscarves to hide their hair loss and not to experience alopecia. The women who lost their hair worried that their spouses would not like them anymore and the majority preferred to hide their alopecia not to worry their children. Besides, they avoided entering social circles because alopecia made their disease visible. It was seen that those who knew that they would lose their hair, who believed that it was their destiny, and who had support systems accepted their situation more easily. The study results provide detailed information on how women perceived hair loss and will contribute to identifying nursing interventions that will help improve adaptability to alopecia and coping mechanisms.

Permanent hair loss associated with taxane chemotherapy use in breast cancer: A retrospective survey at two tertiary UK cancer centres.

Taxane chemotherapy is commonly used in the management of breast cancer. Hair loss (alopecia) is an expected side effect which may have a significant effect on quality of life. Alopecia is normally temporary but permanent chemotherapy-induced alopecia (pCIA) is increasingly recognised especially following docetaxel chemotherapy. However, the prevalence following docetaxel is not well understood and there is no published literature for paclitaxel chemotherapy. The aim of this study is to investigate the prevalence and patterns of pCIA resulting from both docetaxel and paclitaxel chemotherapy at two tertiary UK cancer centres. In collaboration between Clatterbridge Cancer Centre and The Christie NHS Foundation Trusts, a retrospective survey was conducted for breast cancer patients who had received taxane chemotherapy in the neoadjuvant and adjuvant settings. Patients who had concluded chemotherapy at least a year previously were contacted by post and invited to participate by completing a questionnaire and returning it to their treatment centre. Data collected included the incidence and pattern of pCIA using the Savin pictorial hair loss scale, and the methods used by patients to manage it. Fisher's exact test was used to compare pCIA between the docetaxel and paclitaxel cohorts. 383 patients responded to the survey (a 63.3% overall response rate). These comprised 245 patients receiving docetaxel and 138 patients treated with paclitaxel. pCIA was reported by 23.3% of patients receiving docetaxel and 10.1% paclitaxel (p<0.01). Overall 16.7% of patients in both groups reported the ongoing use of products or appliances such as wigs to camouflage their pCIA. In the docetaxel group, pCIA appeared to be more frequent in post-menopausal women than peri- or pre-menopausal women (37.8%, 12.3% and 19.6% respectively [Chi-square test p<0.01]). Also in the docetaxel group, there appeared to be a trend for more severe scalp alopecia when the patient also received an aromatase inhibitor (AI) or tamoxifen and this difference was most marked in those who had received both an AI and tamoxifen as components of their treatment regime (p=0.04). The use of scalp cooling was only recorded in the Christie paclitaxel group (n=12). Of these 12 patients, 83.3% reported no hair loss. While overall rates of permanent eyebrow, eyelash and nostril hair loss were low, this pattern of hair loss appeared more frequent in the paclitaxel than the docetaxel group 4.3% vs. 1.8% (p=0.29). Both docetaxel and paclitaxel may cause permanent scalp hair loss, but it is significantly more prevalent with docetaxel compared with paclitaxel. Clinicians should counsel patients regarding the risk of permanent alopecia prior to embarking upon taxane chemotherapy and routinely offer scalp cooling if available. More research is required to understand the pathobiology of this important and previously under recognised long-term side effect to enable more active preventive and management approaches.

A Limb Hypothermia Wearable for Chemotherapy-Induced Peripheral Neuropathy: A Mixed-Methods Approach in Medical Product Development.

Chemotherapy-Induced Peripheral Neuropathy (CIPN) is a common dose-limiting side-effect of taxane-based chemotherapy, causing progressive and often irreversible pain/sensitivity in the hands and feet. Prevention/treatments for CIPN are not well-developed and urgently needed. Limb cryocompression during chemotherapy has demonstrated promising early data of preventing/reducing CIPN severity. Currently there are no medical devices available that are dedicated to the specific requirements of CIPN prevention. As part of our ongoing development of a dedicated CIPN-prevention limb cryocompression system, this study documents the design & development of the wearable arm wrap, a central component of the system, from initial concept to a trial-ready prototype. A collaborative and multidisciplinary approach was adopted to address the complex and high-risk nature of this SME (Small Medium Enterprise)-centered medical device design & development process. The complementary collaboration unites multidisciplinary expertise spanning the scope of the project. Alongside the clinical, academic, and design & development expertise, the integration of commercial expertise is imperative to promote the market viability, and ultimate success, of the development. As the global leading experts in scalp cooling specializing in the prevention of chemotherapy-induced alopecia, UK-based SME Paxman Coolers Ltd is optimally positioned to support the commercial and regulatory dimensions. Development and adoption of a novel mixed-methodology (HudPAX) facilitated the integration of evidence-based and user-centered techniques to optimize the design & development approach and ensure integration of all critical design inputs. Alpha prototypes were designed through evidence-based approaches, with data from existing clinical trials utilized to determine the preliminary design inputs, alongside 3D ergonomic data. Investigations utilized computer-aided design, rapid prototyping, additive manufacturing, sketch modeling, and fast ideation. User-based approaches facilitated stakeholder-feedback through expert focus groups, informing further design & development and projecting the design into the next stage, Beta prototyping, for use in large-scale efficacy trials and upscaling manufacturing. This paper demonstrates a novel mixed-methods approach, which promotes cross-sector multidisciplinary collaboration, to address the complex multi-layered challenges posed by an early-stage medical device design & development process.

Safety and efficacy of scalp cooling system in preventing chemotherapy induced alopecia - A single center prospective study

BackgroundAlopecia is one of the most common and afflicting side effects associated with chemotherapy treatments. Scalp-cooling devices were introduced to reduce hair loss and improve the hair volume recovery in patients undergoing chemotherapy. MethodsThis is a single center, prospective observational study conducted from 01 February 2019 to 31 January 2020, in patients undergoing chemotherapy for various cancers. The extent of alopecia was assessed by two independent clinicians by reviewing the photographs taken at baseline, during each session, and 4 weeks from the last scalp cooling session. ResultsA total of 100 patients (female: 94 and male: 6) were enrolled in the study, with a mean age of 53.5 years. Of 100 patients, 40 received anthracycline based chemotherapy, 45 received taxane based chemotherapy, 9 received both, and 6 received other chemotherapeutic agents. By the end of the study, 31 patients experienced grade 0–1 alopecia and 69 patients had grade 2 alopecia. On multivariate analysis, chemotherapeutic agent was found to be an independent factor for delaying the onset of Grade 2 alopecia (anthracycline vs taxanes (OR: 0.71; 95% CI (0.51–0.92); P ≤ 0.04)The most common adverse events reported during the scalp cooling sessions were chills (7%), and chills with headaches (6%). Scalp metastasis and scalp cooling discontinuation rates were observed to be very rare. No serious adverse events related to device were observed. ConclusionScalp cooling was observed to be more effective in reducing chemotherapy-induced alopecia in patients treated with taxane-based chemotherapy over anthracyclines. Scalp cooling sessions were well tolerated. Scalp metastasis and scalp cooling discontinuation was observed to be very rare.

The Effect of Orientation on the Performance of Small Free-Convection Heat Sinks for Use With a Thermoelectric Cryotherapy Device

Abstract The rapid development of metal 3D printing techniques has enabled the exploration of complex free-convection heat sink designs. Small free-convection heat sinks with pin-fin arrays (or novel geometries) are widely employed at different orientations in a variety of electronic devices, yet there is limited understanding of how orientation impacts their heat transfer behavior. This article characterizes the orientation-dependent performance of a small, tapered pin, free-convection heat sink (named HS17) manufactured with direct metal laser sintering for use with a thermoelectric scalp cryotherapy device for the prevention of chemotherapy-induced alopecia. A validated numerical model and custom-built free-convection test rig were used to investigate the heat sink’s performance over the orientation range of 0 deg to 135 deg. HS17 maintained relatively robust performance over the 0 deg to 90 deg range; however, the thermal resistance (Rth) at 112.5 deg and 135 deg was 6% and 11% higher compared to the 90 deg case, respectively. The heat sink design was modified to include a 22.5 deg wedge base (named HS17-W) to mitigate this performance decline, which is important to ensure safe and continued operation of the cryotherapy device. Compared to the flat base heat sink, the wedge-base design successfully reduced Rth from 11.9 K/W, 12.5 K/W, and 12.8 K/W to 11.5 K/W, 11.8 K/W, and 12.3 K/W at 90 deg, 112.5 deg, and 135 deg, respectively. These results demonstrate the effectiveness of the current proposed design to improve the performance of free-convection heat sinks at downward-facing orientations.

Effectiveness and Determinant Factors of Successfull Scalp Cooling in Preventing Chemotherapy Induced Alopecia in Breast Cancer Patients : Literature Review

Background: Chemotherapy induced Alopecia (CIA) is one of the most complained and cause the highest distress in breast cancer patients with chemotherapy. Cryotherapy or Scalp Cooling is an alternative intervention to reduce metabolism of cytotoxic agents against hair follicle by lowering the temperature of the scalp. Literature that discusses the effectiveness of Cryotherapy in breast cancer patients is still limited.Objective: Summarize and investigate the effect of Cryotherapy on preventing Chemotherapy induced Alopecia in breast cancer patients and its determinant factors of successfull Cryotherapy . Design: Literature ReviewData Sources: A search was performed by using Ebscohost, Scopus, Science Direct, and ProQuest database from 2009 to 2019 for research article.Review methods: A systematic process was used to analyze and extract data include studies using CASP.Result: From 278 articles that have been observed using CASP, only 10 articles match the inclusion criteria. Total respondents in 10 articles were 1201 breast cancer patients undergoing chemotherapy. All articles used in this study showed positive results about the effect of Cryotherapy on decreasing the severity of Chemotherapy Induced Alopecia (CIA) measured by hair preservation, hair loss, hair regrowth, and decreasing use a wig or head covering. The importance of continuously monitoring the patient's condition to manage the side effects caused by Cryotherapy such as headaches, cold, and nausea.Conclusion:Cryotherapy significantly reduce the severity of CIA by inhibit the process of mitosis and vasoconstriction. There are several factors that must be considered when giving Cryotherapy, such as type of chemotherapy, dosages, device, duration of administration, and temperature. For further research, it is important to considered some factors that can affect the successfull of Cryotherapy and the patient response

15995 Geographic disparities in access to scalp cooling for the prevention of chemotherapy-induced alopecia in the United States

Background: Chemotherapy-induced alopecia (CIA) is a challenging experience for patients undergoing cancer treatment. Scalp cooling, including machine scalp cooling and manual cold caps, can prevent the extent of hair loss in patients receiving cytotoxic chemotherapy. We aim to evaluate geographic disparities in access to scalp cooling in the United States.

Scalp Cooling Impact in Alopecia of Patients Under Treatment for Breast Cancer—Literature Review

Chemotherapy-induced alopecia is a common side effect of breast cancer therapies. Thus, the objective of this study was to carry out a bibliographic survey concerning the effectiveness of scalp cooling in alopecia of patients undergoing treatment for breast cancer. The search was conducted in the databases LILACS (Latin American and Caribbean Literature in Health Sciences), PubMed, Science Direct, Scopus, and Web of Science, by using “scalp cooling” AND “breast cancer” as search terms. Articles from the last 5 years were selected, which included cohort studies, case reports, and randomized studies. The final sample consisted of 16 publications. Data from the studies revealed that the use of hypothermic cap was effective in reducing alopecia. In addition, factors such as temperature and time of cap usage, dose and combination of medications, and hair care influenced in the reduction of hair loss. It was possible to observe that treatment schedules without anthracyclines were more responsive to the effects of scalp cooling, reducing hair loss. Therefore, this study gathered relevant information, showing that scalp cooling is effective and its use should be encouraged by health professionals.