Scalp cooling reduces chemotherapy hair loss, and longer cooling may work best

Design

Systematic review and network meta-analysis of 12 randomised trials

Population

736 patients receiving chemotherapy

Primary outcome

Hair preservation

Effect

Prolonged cooling vs usual care RR 24.66 (7.07–86.05); vs traditional RR 2.13 (1.15–3.93)

A network meta-analysis in Supportive Care in Cancer included 12 randomised trials (736 patients) comparing scalp cooling of different durations, scalp compression, drugs and usual care for preventing chemotherapy-induced alopecia.

Scalp cooling continued for more than 90 minutes after chemotherapy ranked highest. It was associated with much better hair preservation than usual care and than drug treatments, and better than the traditional 46–90 minutes. Its advantage over short cooling (under 45 minutes) was not statistically significant. Most trials had a high risk of bias, and certainty was low to very low.

Hair loss is among the side effects patients fear most, and some decline chemotherapy because of it. Scalp cooling is established as effective for some regimens; this analysis adds that duration may matter.

Offer scalp cooling where available to patients receiving regimens for which it is used, and consider longer post-infusion cooling. The size of the duration effect is uncertain.

• Offer scalp cooling to patients starting chemotherapy regimens likely to cause hair loss, where available
• Consider continuing cooling beyond 90 minutes after the infusion
• Tell patients that drug treatments have not been shown to prevent chemotherapy hair loss
• Set expectations: cooling reduces hair loss but does not prevent it for everyone

Why it matters

Hair loss is a reason some patients refuse treatment, and it is partly preventable.

Don't overread it

Low to very low certainty, and the advantage of prolonged over short cooling was not significant.

The statistics, in plain English

The RR of 24.66 versus usual care has an interval from 7 to 86, very wide because the trials were small; the direction is clear, the size is not. SUCRA ranks treatments but does not show how large the differences between them are.

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