Use Of Scalp Research Articles

A Clinical and Biological Guide for Understanding Chemotherapy-Induced Alopecia and Its Prevention.

Chemotherapy-induced alopecia (CIA) represents perhaps the most distressing side effect of chemotherapeutic agents and is of huge concern to the majority of patients. Scalp cooling is currently the only safe option to combat CIA. Clinical and biological evidence suggests improvements can be made, including efficacy in delivering adequately low temperature to the scalp and patient-specific cap design. The increased use of scalp cooling, an understanding of how to deliver it most effectively, and biological evidence-based approaches to improve its efficacy have enormous potential to ease the psychological burden of CIA, as this could lead to improvements in treatment and patient quality-of-life.

Scalp Hypothermia for Preventing Alopecia During Chemotherapy. A Systematic Review and Meta-Analysis of Randomized Controlled Trials

BackgroundAlopecia is a side effect of chemotherapy and affects a patient's quality of life. Cooling the scalp during chemotherapy might reduce alopecia. The objective of this systematic and meta-analysis was to examine the effects of scalp cooling on the end point of alopecia in randomized controlled trials. Materials and MethodsPreferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. Electronic searches of databases were undertaken through February 2017. In addition other sources were searched. All languages were considered for evaluation. Data were collected and evaluated using a data collection form. Assessment of biases was undertaken using Cochrane methods. When studies could be combined, binary outcomes were evaluated using risk ratio assessment and continuous outcomes were assessed using mean difference (MD). Confidence intervals (CIs) were included and heterogeneity using the I2 statistic. Grading of Recommendations, Assessment, Development, and Evaluation assessments were also made. ResultsTen studies were included in the analysis comprised of 654 patients. Most were patients with breast cancer 432 patients [66%] mainly receiving anthracyclines. For the binary outcome of < 50% versus > 50% alopecia, the use of scalp cooling reduced relative risk (RR) of alopecia by 43% (RR, 0.57; 95% CI, 0.45-0.72; I2 = 11%; P < .00001). For ordinal outcomes (alopecia on a scale of 0-3), use of scalp cooling significantly reduced alopecia (MD, −0.80; 95% CI, −1.19 to −0.41; I2 = 0%; P < .0001). The quality of the evidence was graded as moderate. ConclusionThis systematic review and meta-analysis supports the use of scalp cooling to prevent alopecia in patients with solid tumors undergoing chemotherapy.

Association Between Use of a Scalp Cooling Device and Alopecia After Chemotherapy for Breast Cancer

Chemotherapy-induced alopecia is a common and distressing adverse effect. In previous studies of scalp cooling to prevent chemotherapy-induced alopecia, conclusions have been limited. To evaluate whether use of a scalp cooling system is associated with a lower amount of hair loss among women receiving specific chemotherapy regimens for early-stage breast cancer and to assess related changes in quality of life. A prospective cohort study conducted at 5 US medical centers of women with stage I or II breast cancer receiving adjuvant or neoadjuvant chemotherapy regimens excluding sequential or combination anthracycline and taxane (106 patients in the scalp cooling group and 16 in the control group; 14 matched by both age and chemotherapy regimen). The study was conducted between August 2013 and October 2014 with ongoing annual follow-up for 5 years. Use of a scalp cooling system. Scalp cooling was initiated 30 minutes prior to each chemotherapy cycle, with scalp temperature maintained at 3°C (37°F) throughout chemotherapy and for 90 minutes to 120 minutes afterward. Self-estimated hair loss using the Dean scale was assessed 4 weeks after the last dose of chemotherapy by unblinded patient review of 5 photographs. A Dean scale score of 0 to 2 (≤50% hair loss) was defined as treatment success. A positive association between scalp cooling and reduced risk of hair loss would be demonstrated if 50% or more of patients in the scalp cooling group achieved treatment success, with the lower bound of the 95% CI greater than 40% of the success proportion. Quality of life was assessed at baseline, at the start of the last chemotherapy cycle, and 1 month later. Median follow-up was 29.5 months. Among the 122 patients in the study, the mean age was 53 years (range, 28-77 years); 77.0% were white, 9.0% were black, and 10.7% were Asian; and the mean duration of chemotherapy was 2.3 months (median, 2.1 months). No participants in the scalp cooling group received anthracyclines. Hair loss of 50% or less (Dean score of 0-2) was seen in 67 of 101 patients (66.3%; 95% CI, 56.2%-75.4%) evaluable for alopecia in the scalp cooling group vs 0 of 16 patients (0%) in the control group (P < .001). Three of 5 quality-of-life measures were significantly better 1 month after the end of chemotherapy in the scalp cooling group. Of patients who underwent scalp cooling, 27.3% (95% CI, 18.0%-36.6%) reported feeling less physically attractive compared with 56.3% (95% CI, 31.9%-80.6%) of patients in the control group (P = .02). Of the 106 patients in the scalp cooling group, 4 (3.8%) experienced the adverse event of mild headache and 3 (2.8%) discontinued scalp cooling due to feeling cold. Among women undergoing non-anthracycline-based adjuvant chemotherapy for early-stage breast cancer, the use of scalp cooling vs no scalp cooling was associated with less hair loss at 4 weeks after the last dose of chemotherapy. Further research is needed to assess outcomes after patients receive anthracycline regimens, longer-term measures of alopecia, and adverse effects. clinicaltrials.gov Identifier: NCT01831024.

EXPERIENCE OF SCALP COOLING FOR PREVENTION CHEMOTHERAPY-INDUCED HAIR LOSS

Short-term results of using Orbis II Paxman device for prevention of chemotherapy-induced alopecia were analyzed. A total of 98 sessions of scalp cooling were performed in 32 patients. Twenty-four (80 %) scalpcooled patients had good hair preservation. The level of comfort during the procedure was 87 %. Patients with breast cancer underwent 55 scalp cooling sessions. Good hair preservation was observed in 88% of cases. Grade 1 and 2 alopecia was observed in 12% of patients. Thus, the data obtained confirm that the use of scalp cooling methods can improve the quality of life for patients receiving chemotherapy.

The use of scalp cooling for chemotherapy-induced hair loss

Chemotherapy-induced hair loss is a common and distressing side effect of cancer therapy and is one of the major unmet challenges in cancer management. Scalp cooling can prevent chemotherapy-induced hair loss in some cancer patients with solid tumours receiving certain chemotherapy regimens. Recent evidence indicates that this technique does not increase the risk of scalp metastasis. A reduction in post-chemotherapy infusion duration of scalp cooling and the advancement in cool cap technology may assist clinicians in promoting scalp cooling to cancer patients. This article discusses recent research, scalp cooling guidelines, products available and implications for nurses and their organisations in providing scalp cooling. It also considers recent advancements in identifying genes associated with chemotherapy-induced hair loss and international research collaborations including a registry and a 'chemotherapy-induced hair loss action group'--all striving to improve the patient experience of chemotherapy-induced hair loss.

Cold thermal injury from cold caps used for the prevention of chemotherapy-induced alopecia.

The use of scalp cooling for the prevention of chemotherapy-induced alopecia (CIA) is increasing. Cold caps are placed onto the hair-bearing areas of the scalp for varying time periods before, during, and after cytotoxic chemotherapy. Although not yet reported, improper application procedures could result in adverse events (AEs). At present, there are no evidence-based scalp cooling protocols, and there is no regulatory oversight of their use. To report the occurrence of cold thermal injury (frostbite) on the scalp, following the use of cold caps for the prevention of CIA. We identified four patients who developed cold thermal injuries on the scalp following the application of cold caps. Medical records were analyzed to retrieve the demographic and clinical characteristics. The cold thermal injuries in our patients were grade 1/2 in severity and improved with topical interventionsand interruption of cold cap use, although grade 1 persistent alopecia ensued in 3 patients. The true incidence of such injuries in this setting, however, remains unknown. Cold thermal injuries are likely infrequent and preventable AEs that may result from improper device application procedures during cold cap use. Although these untoward events are usually mild to moderate in severity, the potential occurrence of long-term sequelae (e.g., permanent alopecia and scarring) or the need to discontinue cold cap use, are not known. Prospective studies are needed to further elucidate the risk and standardize healthcare delivery methods, and to improve patient/supportive/healthcare provider education.

Scalp cooling: management option for chemotherapy-induced alopecia.

Chemotherapy is increasingly being administered as a treatment for cancer and with it are a number of possible side effects. One, which has a negative impact on a patient's quality of life and their self-esteem, is that of chemotherapy-induced alopecia (CIA). A side effect of which, for some, could be prevented by the use of scalp cooling, dependent on the regimen being administered and patient choice. This article explores the issue of CIA from the patient's perspective and scalp cooling as a preventative measure, along with a review of the evidence around the risk associated with developing scalp metastases following scalp cooling. It also discusses why scalp cooling should be available for both male and female patients; along with the potential impact scalp cooling may have on clinical areas delivering chemotherapy.

Chemo-induced hair loss: prevention of a distressing side-effect

temperature of below 15˚C. Both scalp cooling techniques require a pre-cooling time of 30 minutes for the cap to be maintained during chemotherapy administration and 1–3 hours post cooling time, which is dependent on the chemotherapy drugs administered. Post-cooling time is dependent on the chemotherapy drug but is generally 45–90 minutes. Van den Hurk et al (2012) conducted a large prospective multi-centre study on scalp cooling in patients having chemotherapy. It aimed to provide patient information by estimating the results of scalp cooling in chemotherapy regimens. Characteristics associated with these results were also identified in order to provide a better understanding of the determinants that may improve scalp cooling results. The results were recorded in the open patient registry; they were positive for most chemotherapy regimens, justifying the use of scalp cooling by all eligible patients. Most patients tolerated scalp cooling well, with common side-effects including transient light-headedness, dizziness, headaches and an unpleasant feeling, which can be due to the heaviness of the cap. There was some indication that the success of decreasing chemotherapyinduced hair loss may be dependant on a combination of factors including the

Prospective cohort study of chemotherapy-induced alopecia with or without scalp cooling.

9138 Background: Scalp cooling can prevent chemotherapy-induced alopecia. Success varies according to the type of chemotherapy. A controversy exists regarding the use of scalp cooling because of the lack of efficacy data with modern chemotherapy regimen and safety data. We present a prospective cohort study design to measure alopecia. Methods: The prospective study was conducted at the Centre des Maladies du Sein Deschênes-Fabia (CMS) in Quebec City (where scalp cooling is offered routinely and 85% of women use it) and at the Centre Hospitalier Universitaire de Montreal (CHUM), in Montreal (where scalp cooling is not available). Women were eligible if they were going to receive neoadjuvant or adjuvant chemotherapy for breast cancer. The study involved completion of questionnaires (on degree of alopecia, hair type, hair care, use of head accessories, tolerance to scalp cooling and questions related to sick leave from work) and having pictures taken at baseline, cycle 3 and at the last cycle of chemotherapy. For the last 43 patients, the EORTC QLQ-C30/BR23 and an adaptation for Hairdex were added. Results: A total of 136 patients were recruited (110 at CMS over 2 years and 26 at the CHUM over a 9-month period). Preliminary efficacy results are shown in the Table (data on quality of life have not yet been analyzed). Hair preservation was defined as a SUCCESS for hair loss (since the beginning of chemotherapy) characterized as “not at all”, “a little” or “moderate” and “FAILURE” when characterized as “a lot” or “all” or “hair shaved”. Overall, in the scalp cooling group, 34% were considered a “success” using hairdresser evaluation and 49% using patient evaluation; for the non scalp-cooling group, these rates were 9% and 4% respectively. Conclusions: Scalp cooling appears to be efficacious for preventing chemotherapy-induced alopecia in this exploratory cohort study. [Table: see text]

P5-20-08: Multicenter Results of Scalp Cooling To Prevent Chemotherapy-Induced Alopecia in 1500 Breast Cancer Patients.

Abstract Background Chemotherapy-induced alopecia (CIA) is a frequent occurring side effect of cancer treatment that has high psychological impact on many patients and their relatives. CIA may be prevented by scalp cooling. Methods Breast cancer patients who received scalp cooling could participate in this registration study from 2006 and onwards. Nurses and patients completed questionnaires. Scalp cooling was performed using the Paxman PSC1 or PSC2 system and was considered satisfying when patients did not wear a wig or head cover. Logistic regression analyses will be used to examine determinants of the scalp cooling result, including age, type/length/thickness/chemical manipulation (dyeing, waving, colouring) of hair, type/dose of chemotherapy, cytostatic infusion time, post-infusion cooling time, dampening hair or use of conditioner before scalp cooling and previous treatment with chemotherapy. Results The use of scalp cooling increased from 4 hospitals in 2005 to 60 out of 100 Dutch hospitals in 2011. The registration comprised about 1500 scalp cooled breast cancer patients of whom 79% were treated in the adjuvant setting. Overall, patients’ satisfaction with the result of scalp cooling was 50%, but varied for different chemotherapy schemes and dosages from 8% in docetaxel 75 mg/m2, doxorubicin 50 mg/m2, cyclophosphamide 500 mg/m2 (TAC) to 81% in paclitaxel 70–90 mg/m2. The results of the regression analyses will be presented at the conference. Discussion Scalp cooling is effective in most commonly used chemotherapy regimens for breast cancer patients. Therefore, scalp cooling should be offered more often. Efficacy depends on the type and dose of chemotherapy. Other factors influencing the result have never been studied in multivariate analyses before. Scalp cooling is ineffective in patients treated with a combination of a taxane and an anthracyclin. The frequent use of scalp cooling in the adjuvant setting indicates minimal fear for an increased incidence of scalp skin metastases after scalp cooling in breast cancer patients. Multicenter registration of results improves information for medical professionals and patients and will lead to more frequent use of scalp cooling and improvement of the method. Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P5-20-08.

P5-20-06: Survival in Women with Breast Cancer Who Used or Did Not Use Scalp Cooling in the Neoadjuvant/Adjuvant Setting.

Abstract Background Scalp cooling can prevent chemotherapy-induced alopecia. Success varies according to the type of chemotherapy. A controversy exists regarding the use of scalp cooling because of the lack of safety data. No data are available regarding the impact on survival. Purpose: To compare overall survival in women who used or did not use scalp cooling in the neoadjuvant/adjuvant setting. Method: The survival of women treated in a specialized breast cancer centre (the Centre des Maladies du Sein Deschěnes-Fabia) in Quebec City who all used scalp cooling was compared to that of a population-based random sample of women treated in other regions of the province of Quebec (Canada) where scalp cooling is not available. Cox proportional hazard models were used. Results: Overall, survival was comparable (and possibly better although not at a conventionally statistically significant level: HR = 0.80, 95 % CI: 0.63−1.01, p=0.06) among the 553 women who used scalp cooling compared to the 817 who did not. An interaction was found between scalp cooling and treatment in the adjuvant vs. neoadjuvant setting (p-interaction=0.015). In the adjuvant setting (n=485 scalp cooling and 740 no scalp cooling), the crude HR (in favour of scalp cooling) was 0.66 (95% CI: 0.50−0.87, p=0.003). In the neoadjuvant setting (n=68 scalp cooling and 77 no scalp cooling), the HR was 1.40 (95% CI: 0.84−2.33, p=0.2). No interaction was found with stage. Conclusion: This is the first study to compare survival of women who used scalp cooling to that of women who did not. Scalp cooling to prevent chemotherapy-induced alopecia had no negative effect on survival in women with breast cancer who used it. Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P5-20-06.

Breast cancer scalp metastasis as first metastatic site after scalp cooling: Two cases of occurrence after 7- and 9-year follow-up

Chemotherapy-induced alopecia is a commonly feared chemotherapy side effect and can be prevented using scalp cooling. Scalp metastasis is a rare site of recurrence. There is a question about whether or not the risk might be increased with the use of scalp cooling. Two cases of breast cancer with scalp metastases as first metastatic site are presented. The first patient presented with a scalp metastasis as first metastatic site 9 years following breast cancer chemotherapy treatments; she used scalp cooling for the adjuvant treatment. Second case presented a scalp metastasis as first metastatic site 7 years following treatments for her first cancer; overall, she used scalp cooling in only one of her six adjuvant chemotherapy cycles. Scalp metastases as the first site of recurrence are very rare entities. Scalp cooling is unlikely to have contributed in the cases presented here.

Does combing the scalp reduce scalp electrode impedances?

Electrical activity from the human brain can be recorded via electrodes on the scalp. It is important to reduce the impedance of each electrode to minimize unwanted noise in the recording. Electrode impedance can be improved by abrading the skin to remove dead skin cells. In this experiment, we tested if abrading the skin by combing the scalp leads to a significant reduction in electrode impedance. We compared the mean electrode impedance values of 20 subjects whose scalps were combed prior to electrode cap placement, with 20 subjects whose scalps were not combed. Combing significantly reduced the impedances at central, right, and left areas of the scalp. This finding supports the use of scalp combing to reduce the time and subject discomfort that can be associated with placing scalp electrodes. This is particularly important for experiments testing children.

Managing consumer demands

When I wrote about the use of scalp cooling in a systematic review I performed in 1997, I described it as a consumer-led development with an inadequate evidence base. I suggested that it challenged service providers to find the capacity and staffing resource to make scalp cooling available for patients. Since that time, the evidence base for alopecia prevention has continued to grow. In this issue ofCNP, Lisa Doherty’s study adds

Hair loss with chemotherapy: at a loss over its management?

Alopecia is a common side effect of chemotherapy treatments for cancer; for some individuals this results in complete hair loss. The extent of this depends on many factors including the type or combination of drugs administered, and their doses. Further, it can in some cases be lessened through use of scalp cooling techniques. This method of reducing hair loss has been available since the 1970s. However, previous evidence suggests that nurses are apathetic about its use, which in turn might mean that patients are not always offered this intervention. This small exploratory study investigated perceptions held by nurses administering chemotherapy towards alopecia and its management through scalp cooling. It entailed completion of a survey questionnaire by 13 nurses that regularly administered intravenous chemotherapy. These data were then augmented by those attained from follow-up, semi-structured interviews that were conducted with three of the sample. It determined that perceptions of scalp cooling were influenced by individuals' subjective notions of its efficacy constructed from their experiences of having administered scalp cooling. Furthermore, attempts to prevent hair loss were mediated by their cognitions of the experience of hair loss itself. This study determined that views held about scalp cooling varied considerably, and that it was unlikely to be offered to all suitable patients or administered in a systematic manner. Such variation in provision has implications both for patients wishing to access this treatment and for nurses wishing to audit its use and efficacy.

A study day for nurses caring for patients experiencing chemotherapy induced alopecia and the effective use of scalp cooling equipment

A study day for nurses caring for patients experiencing chemotherapy induced alopecia and the effective use of scalp cooling equipment

A pilot study to assess the feasibility of prior scalp cooling with palliative whole brain radiotherapy.

The objective of this work was to perform a feasibility study on the use of scalp cooling during palliative whole brain radiotherapy. Seven patients (1 male, 6 female) with good performance status underwent scalp cooling prior to and during radiotherapy for cerebral metastases. Five patients were prescribed 12 Gy in two fractions and two patients were prescribed 20 Gy in five fractions. Phantom thermoluminescent dosemeter (TLD) studies to assess the build-up effect from the scalp cap were performed. Seven out of eight patients that were offered scalp cooling completed treatment uneventfully. One patient reported discomfort on application of the scalp cap and continued treatment without scalp cooling. No patients reported other adverse effects from use of the cap during treatment or at follow-up. TLD studies demonstrated a 55-80% increase in dose to the scalp after application of the scalp cap. All patients experienced hair loss. Scalp cooling caps are well tolerated through a course of palliative whole brain radiotherapy. The scalp dose is significantly increased owing to a bolus effect from the scalp cap.

The Science of Stretching Skin and its Clinical Application

The new technology that is currently available to the hair restoration surgeon goes beyond the sole use of small hair grafts to restore the bald pate. Current use of scalp stretching concepts and devices has enabled the hair restoration surgeon to efficiently increase the available donor supply of the patient to cover a greater zone of alopecia. The science and clinical application of immediate and prolonged scalp stretching techniques is discussed.

Intrapartum fetal surveillance: The role of fetal scalp blood sampling

Continuous electronic fetal heart rate monitoring and fetal scalp blood sampling have traditionally played a complementary role in intrapartum fetal surveillance. Nevertheless, biochemical assessment of fetal blood pH, with the use of scalp or umbilical cord blood, is often viewed as the “gold standard” against which biophysical indicators of fetal distress must be judged. In actual clinical practice, however, fetal scalp blood sampling is only rerely used. In addition, there is a growing body of evidence to suggest that, when properly interpreted, fetal heart rate assessment may be equal or superior to measurement of fetal blood pH in the prediction of both good and bad fetal outcomes. Under certain circumstances, fetal scalp blood sampling remains a valuable clinical tool; however, we recommend a deemphasis of fetal scalp blood sampling in general clinical practice. Both theoretical and practical considerations suggest that the properly trained clinician may pursue an approach for the detection of fetal distress that does not include scalp blood sampling without either compromising his ability to detect fetal distress or significantly increasing the cesarean section rate.