Scalp cooling system for prevention of chemotherapy induced alopecia: A single center one-year prospective observational study

Alopecia is one of the most common and emotionally distressing side-effects of chemotherapy. Scalp cooling systems are commonly used to prevent chemotherapy induced alopecia. We are presenting our one-year experience with Paxman scalp cooling system. This is a prospective observational study in patients who started scalp cooling while undergoing chemotherapy for various cancers at our center from 1st November 2020 to 31st October 2021 to assess the efficacy, compliance and safety of scalp cooling system. Efficacy was defined by grading alopecia according to the Common terminology criteria for adverse events V4.0, independently by a clinician and a nurse. Withdrawl of patient from scalp cooling anytime after 1st session was defined as failure. A total of 128 patients underwent total 730 scalp cooling sessions. The mean age was 49 years with 123 females and 5 males. Eight patients were on palliative chemotherapy. Breast Cancer (58%) and Ovarian Cancer (23%) patients most commonly utilized scalp cooling system. We had 29% failure or drop-out while 71% were compliant. Among 37 patients who dropped-out, 29 dropped-out after the 1st cycle itself. The most common cause of failure was Grade II alopecia and patient dissatisfaction (25 patients out of which 20 had recieved anthracyclines) followed by cold intolerance (6) and missing scalp cooling due to logistic issues (6). Three patients used scalp cooling successfully while on multi-day chemotherapy. Post anthracycline-based chemotherapy, alopecia grading at the completion showed Grade 0 - 5%, Grade I - 25%, Grade II- 75%. Post taxane-platinum doublet, alopecia grading was- Grade 0 - 30%, Grade I- 58% and Grade II- 12% and after single agent taxane - grade 0 - 60%, grade I- 40%, grade II- nil. The common adverse events reported was chills (8%) , headache (4%) and skin erythema and itching (1%). No serious adverse events or scalp metastasis was observed. Scalp cooling is safe and effective system for reducing chemotherapy induced alopecia with good compliance and patient satisfaction rates. Efficacy is highest for taxanes and platinum-based chemo while poorest for anthracyclines.