Abstract P5-10-02: Decreased rates of chemotherapy-induced alopecia in patients receiving chemotherapy (including anthracyclines) with use of scalp-cooling devices
Authors: Deengar Angad , Vahdat Linda , Dulgher Maxim 
Published: March 2020

Abstract
BACKGROUND: Chemotherapy-induced alopecia (CIA) is a frequent complication that is mostly reversible, however permanent alopecia has been associated with some curative adjuvant regimens. CIA can be decreased through the use of scalp-cooling devices (SCDs) averting the negative psychosocial impact from the change in appearance, however there is little data on the worth of SCDs, especially in anthracycline-based adjuvant regimens.
METHODS: We conducted a retrospective study of 87 women and 3 men with either breast (n=74), ovarian, endometrial or gastric malignancies receiving adjuvant or neoadjuvant chemotherapy at a single infusion center located within a community hospital. We included data for all patients who completed chemotherapy between June 2016 and May 2018, and received SCDs with at least one cycle. All patients were given a list of rules (see below) that would allow the caps to be comfortable, and fit properly. Objective hair-loss (using Common Terminology Criteria for Adverse Events scale, v4.03) was assessed by the same nurse twice - prior to their first session of chemotherapy, and again after the final one. If patients did not continue with SCDs for all chemotherapy cycles, their alopecia grade was assessed at the time of discontinuation. The patients were divided into four groups for analysis based on the chemotherapy regimen: (a) taxane-based, (b) anthracyclines only, (c) combination of anthracyclines & taxane, and those that (d) received neither anthracyclines or taxanes. The taxane-based group included patients who received any of the following: Abraxane, paclitaxel, Abraxane-Herceptin, taxol/carboplatin, TC, TCH, TCHP, TH or THP. All patients used the Dignicap™ Cold-Cap, and each patient had a designated capper for each chemotherapy session. A capper is a caregiver specifically trained to facilitate the appropriate fitting and use of a scalp-cooling device during chemotherapy.
RESULTS: Among the 90 patients (Table 1), 29 received anthracyclines (86% in combination with taxanes). Of these, 18 (62%) had alopecia grade 1 after completing treatment. Out of the 36 taxane-based patients to be both compliant and received SCD with all chemotherapy cycles, 33 (92%) had grade 1 alopecia. In the cohort of 7 patients who received neither anthracyclines or taxanes, none had an alopecia grade of 2. Overall compliance was 89%.
CONCULSION: At our community-based infusion center, SCDs reduced rates of CIA with all regimens of chemotherapy, including those receiving anthracycline-based chemotherapy (32% of total patients). The low rate of alopecia is most likely facilitated by educating the patients on hair-care in between cycles and the use of a capper for each patient. Compliance with our rules can improve efficacy of cold-caps and can be beneficial in preventing alopecia.
Cold Cap Patient RulesHair washed weekly with sulfate-free shampooDry shampoo allowedNo cutting/color-processing of hairPowder color products allowedNo blow dryersComb hair daily with wide tooth combs onlyElectric warming blankets during chemotherapy
Table 1: Summary of resultsChemotherapy Regime (n=90)Grade 1 alopecia, n (%)Grade 2 alopecia, n (%)Taxane (54)43 (80)11 (20)Combination of anthracyclines & taxanes (25)15 (60)10 (40)Anthracycline only (4)3 (75)1 (25)Neither anthracycline or taxane (7)7(100)0 (0)
Citation Format: Angad Deengar, Linda Vahdat, Maxim Dulgher. Decreased rates of chemotherapy-induced alopecia in patients receiving chemotherapy (including anthracyclines) with use of scalp-cooling devices [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P5-10-02.