Is It Time to Offer Scalp Cooling to Prevent Chemo-Induced Hair Loss?

New clinical trials have shown that a scalp-cooling cap can reduce chemotherapy-induced hair loss in breast cancer patients, and Columbia University and NewYork-Presbyterian oncologist Dawn Hershman, MD, says the time is right for U.S. providers to offer the treatment to their patients.

In an editorial published in the Feb. 14 issue of JAMA, Dr. Hershman writes that hair loss is “one of the strongest deterrents for a woman who is deciding whether to undergo chemotherapy.  Interventions, such as scalp cooling, that reduce treatment-associated toxic effects may help ease the distress associated with chemotherapy and improve outcomes for patients.”

The treatment is available in Europe and is increasingly offered at many institutions in the United States.

Chemotherapy is a mainstay of breast cancer therapy and reduces the risk of death by up to 35 percent. But according to one study, 8 percent of women diagnosed with breast cancer may be at risk of avoiding chemotherapy because of their fear of losing their hair.

“The medical community has gone to great lengths to reduce the risk of side effects—such as nausea, fever, early menopause, and even infertility—that may interfere with the initiation or continuation of breast cancer chemotherapy,” says Dr. Hershman. “But when it comes to preventing significant hair loss, we have made very little progress.”

Scalp cooling is thought to prevent hair loss by reducing blood flow—and the resulting flow of chemotherapy drugs—to the hair follicles. Patients wear a cooling cap during chemotherapy sessions and for 90 minutes after treatment.

Two new studies, published in the same issue of JAMA, showed that 5 percent of women who wore the cooling cap during chemotherapy experienced no hair loss and about 50-60 percent experienced less than 50 percent hair loss. In contrast, all of the women in the studies who did not wear the cap had greater than 50 percent hair loss.

Scalp cooling is not yet covered by insurance, but Dr. Hershman is hopeful that regulators will view the potential benefits as more than cosmetic.

“Reassuring patients that symptoms can be controlled may help persuade them to initiate treatment and may lead to improvements in quality of life and survival,” she says.

Dr. Hershman is professor of medicine at Columbia University’s College of Physicians & Surgeons, an oncologist at the Herbert Irving Comprehensive Cancer Center, and professor of epidemiology at Columbia's Mailman School of Public Health.