Scalp Cooling A literature review of efficacy, safety, and tolerability for chemotherapy-induced alopecica

BACKGROUND: More than 75% of patients with cancer cite alopecia as the most feared side effect of treatment, with as many as 10% considering treatment refusal. Despite wide acceptance in other countries, scalp cooling to reduce chemotherapy-induced alopecia (CIA) has been uncommon in the United States because of longstanding concerns of scalp metastases and a lack of reliable efficacy data. OBJECTIVES: This article reviews 40 years of efficacy, safety, and tolerability literature on scalp cooling to prevent CIA. METHODS: A systematic review was performed in PubMed and CINAHL (R). Forty articles were reviewed, with 12 articles demonstrating high levels of evidence and meeting inclusion criteria. Comparative trials, systematic reviews, and one large single-arm trial were included. FINDINGS: Scalp cooling efficacy is dependent on many factors but demonstrates better hair preservation than no cooling. No increase in scalp metastases or statistically significant difference in overall survival was seen in retrospective safety data when cooling was used. Few patients discontinue cooling early because of adverse experiences.