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The effect of scalp cooling on CIA-related quality of life in breast cancer patients: a systematic review

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Abstract

Purpose

Chemotherapy-induced alopecia (CIA) remains a distressing adverse event of cancer treatment but may be prevented by scalp cooling. The effectiveness of scalp cooling, however, is dependent on the chemotherapy regimen with successful hair preservation (i.e., < 50% hair loss) in 41–59% of women on taxane-based therapies in comparison to 16–36% on anthracycline-based therapies. Despite the potential utility, use of scalp cooling has shown a more equivocal impact on quality of life (QoL). In this review, we aim to evaluate the use of scalp cooling for CIA and quantitative QoL measures.

Methods

A systematic review of PubMed, Embase, Web of Science, and Cochrane databases for clinical studies on scalp cooling to prevent CIA published before October 29, 2018 was performed. Clinical studies with 5 or more patients that reported on a quantitative QoL measure were included and graded according to a modified five-point scale from the Oxford Centre for Evidence-Based Medicine.

Results

Studies meeting inclusion criteria included 4 randomized clinical trials (RCT), 8 cohort studies, and 1 cross-sectional study with 1282 unique patients. The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (QLQ-C30: 46%) and Breast Cancer Module (QLQ-BR23: 46%) represented the most commonly used QoL assessments. Overall, 4 (31%) of the 13 studies concluded that scalp cooling was associated with significant improvements in QoL measures; 8 (62%) determined that there was either non-significant or no improvements; and 1 (7.7%) provided a mixed conclusion. Although 2 (50%) RCT demonstrated that scalp cooling can effectively prevent CIA depending on the chemotherapy regimen, these studies did not show that successful hair preservation was associated with improved QoL measures.

Conclusions

This review demonstrates that scalp cooling is not consistently associated with significant QoL improvements as assessed by EORTC QLQ-C30 and -BR23. Representing a critical limitation, more than one-third of the studies did not subcategorize QoL outcomes for successfully or unsuccessfully scalp-cooled patients but rather reported on QoL measures for all scalp-cooled patients in general. Failure to prevent hair loss in patients undergoing an expensive and potentially uncomfortable treatment likely contributes to decreased well-being, impacting the overall distribution of QoL measures in scalp cooling patients compared to controls. Future studies should incorporate validated QoL instruments specific to hair disease and classify QoL outcomes for scalp-cooled patients based on the degree of hair preservation.

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Acknowledgements

We would like to thank Jacqueline Cellini, MLIS, MPH of Countway Library of Medicine and Lisa Liang Philpotts, BSN, MSLS of eTreadwell Virtual Library for their invaluable help in developing and conducting the literature search.

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Authors and Affiliations

  1. Department of Dermatology, Massachusetts General Hospital, 50 Staniford Street, Suite 200, Boston, MA, 02114, USA

    Dustin H. Marks, Jean-Phillip Okhovat, Dina Hagigeorges, Athena J. Manatis-Lornell & Maryanne M. Senna

  2. Department of Hematology/Oncology, Massachusetts General Hospital, Boston, MA, USA

    Steven J. Isakoff

  3. Harvard Medical School, Boston, MA, USA

    Steven J. Isakoff & Maryanne M. Senna

  4. Cornell Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Mario E. Lacouture

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  1. Dustin H. Marks
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Corresponding author

Correspondence to Maryanne M. Senna.

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Conflict of interest

Dr. Lacouture has a consultant/speaking role with Legacy Healthcare Services, Adgero Bio Pharmaceuticals, Amryt Pharmaceuticals, Celldex Therapeutics, Debiopharm, Galderma Research and Development, Johnson and Johnson, Novocure Inc, Lindi, Merck Sharp and Dohme Corporation, Helsinn Healthcare SA, Janssen Research & Development LLC, Menlo Therapeutics, Novartis Pharmaceuticals Corporation, F. Hoffmann-La Roche AG, AbbVie Inc, Boehringer Ingelheim Pharma Gmbh & Co. KG, Allergan Inc, Amgen Inc, E.R. Squibb & Sons LLC, EMD Serono Inc, Astrazeneca Pharmaceuticals LP, Genentech Inc, Leo Pharma Inc, Seattle Genetics, Bayer, Manner SAS, Lutris, Pierre Fabre, Paxman Coolers, Adjucare, Dignitana, Biotechspert, Teva Mexico, Parexel, OnQuality Pharmaceuticals Ltd, Novartis, Harborside, Wiley, and Takeda Millenium. Dr. Lacouture also receives research funding from Berg, Bristol-Myers Squibb, Lutris, Paxman, Novocure, US Biotest, and Veloce, and is funded in part through the NIH/NCI Cancer Center Support Grant P30 CA008748. Mr. Marks declares that he has no conflict of interest. Dr. Okhovat declares that he has no conflict of interest. Ms. Hagigeorges declares that she has no conflict of interest. Ms. Manatis-Lornell declares that she has no conflict of interest. Dr. Isakoff declares that he has no conflict of interest. Dr. Senna declares that she has no conflict of interest.

Informed consent

As this study was a systematic review and did not involve contact with patients or patient information, it was not applicable for Informed consent to be obtained.

Research involving human participants and/or animals

This article does not contain any studies with human participants or animals performed by any of the authors.

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Marks, D.H., Okhovat, JP., Hagigeorges, D. et al. The effect of scalp cooling on CIA-related quality of life in breast cancer patients: a systematic review. Breast Cancer Res Treat 175, 267–276 (2019). https://doi.org/10.1007/s10549-019-05169-0

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