Cooling the scalp before, during, and after chemotherapy with a proprietary scalp cooling device prevents hair loss in at least 50% of women being treated for early-stage breast cancer, although success may depend on the type of chemotherapy women receive and how skilled clinicians are in applying the cooling device.

Two separate studies of two different scalp cooling devices for the prevention of chemotherapy-induced alopecia were published online February 14 in JAMA Oncology. Both report positive results, showing that the devices do prevent some hair loss.

As the investigators explain, lowering the temperature of the scalp constricts blood vessels, reducing both blood flow and the amount of chemotherapy delivered to the hair follicles, which in turn reduces the amount of hair loss.

“At face value, these findings appear to represent a major step forward in improving the quality of life of individuals with cancer,” comments Dawn L. Hershman, MD, from the Herbert Irving Comprehensive Cancer Center at NewYork–Presbyterian/Columbia University Medical Center, New York City, in an accompanying editorial.

However, she adds that the quality-of-life results need to be interpreted with caution. In addition, there are also questions about who will pay for these scalp cooling devices because this is a treatment for temporary hair loss, which “can be perceived as cosmetic.”

Yet, she argues, “[o]ne of the strongest deterrents for a woman who is deciding whether to undergo chemotherapy is concern about alopecia.”

In fact, an estimated 8% of women who might benefit from chemotherapy have indicated that they would refuse treatment because of their fear of hair loss, she adds.

“[I]dentifying interventions, such as scalp cooling for the prevention of chemotherapy-induced alopecia, that reduce or eliminate treatment-associated toxic effects will help ease the distress associated with chemotherapy and may, as a result, improve outcomes for patients with breast cancer,” Dr Hershman concludes.

Author of a second editorial and JAMA Oncology web editor, Howard (Jack) West, MD, Swedish Cancer Institute, Seattle, Washington, agreed, telling Medscape Medical News that clinicians have not prioritized hair preservation during chemotherapy as much as they perhaps should have based on what matters to patients.

Hair loss is not a trivial consequence of chemotherapy for many patients, he emphasized.

“I think many people, especially women, may factor the potential for alopecia into their decision about receiving chemotherapy, and this could potentially lead to patients being undertreated because of their concerns about this side effect,” he said.

“And given that patients are key decision makers in their treatment, I think it really helps when we can demonstrate that we are listening to their concerns and do things to minimize issues that are of greatest concern to them,” he added.

SCALP Trial With Paxman Device

One of the trials used the Orbis Paxman Hair Loss Prevention System (Paxman Coolers Ltd), which is awaiting approval in the United States.

Paxman Scalp Cooling Device. Courtesy of Paxman

The Paxman device is a two-cap system consisting of an inner silicon cap in which refrigerated fluid is circulated and an outer neoprene cap that insulates the scalp. The cap is fitted snugly to the head and is held in place with a chin strap.