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Minimising hair loss during chemotherapy


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Efficacy of scalp cooling in preventing chemotherapy induced alopecia among breast cancer patients receiving adjuvant docetaxel and cyclophosphamide chemotherapy
Received: October 13, 2014Accepted: January 14, 2015Published Online: January 26, 2015 CLINICAL BREAST CANCER Journal
Abstract Background

Chemotherapy induced alopecia (CIA) is a distressing adverse effect of many chemotherapy agents. The TC (docetaxel and cyclophosphamide) chemotherapy regimen is typically associated with complete alopecia. Scalp cooling with cold caps has been reported to minimize or prevent CIA. We conducted a prospective study to assess efficacy of scalp cooling in preventing CIA among women receiving adjuvant TC chemotherapy for breast cancer.


Women at the Weill Cornell Breast Center who independently elected to use scalp cooling with cold caps during adjuvant TC chemotherapy were asked to participate. Degree of hair loss was assessed by a single practitioner using Dean’s alopecia scale (grade 1/excellent (<25% hair loss), grade 2/good (25-50% hair loss), grade3/moderate (50-75% hair loss), grade4/poor (>75% hair loss)), by digital photographs, and by patient self-report of hair thinning and/or the need to wear a wig/head covering. Assessments were made before each chemotherapy treatment and at follow up visit between 3 weeks and 3 months after completion of chemotherapy.


Of 20 evaluable patients, 10% reported a need to wear a wig/head covering at follow up visit. Dean’s alopecia score was excellent for 65% of patients, good for 25% of patients and moderate or poor for 10% of patients. The majority of patients reported hair thinning after every chemotherapy cycle. No patient discontinued therapy due to intolerance of cold caps.


Scalp cooling with cold caps appears to be effective in preventing CIA among the majority of women undergoing chemotherapy with TC chemotherapy.


This article complements earlier experience with Taxotere - that nail damage is minimised by cooling the hands and feet during (slow) infusion.

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Those of you who may have attended the Clinical Oncology Society Australia, Annual Scientific meeting in Dec 2014 in Melb. You possibly may  have seen several stands with “cooling cap refrigerated equipment” being promoted to the medical world, to minimise the hair loss stresses induced concerns for most women, and perhaps some men. But benefits for hands and feet would be great.

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