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Ueberroth BE, Kosiorek HE, Nafissi NN, Ertz-Archambault N, Howland A, Haddad T, Northfelt DW. Patient and nursing staff perspectives on automated scalp cooling (ASC) for chemotherapy-induced alopecia in breast cancer. Support Care Cancer 2024; 32:412. [PMID: 38842732 DOI: 10.1007/s00520-024-08611-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 05/28/2024] [Indexed: 06/07/2024]
Abstract
PURPOSE Automated scalp cooling (ASC) is available to patients undergoing chemotherapy for breast cancer to decrease chemotherapy-induced alopecia. This study sought to elucidate patient and chemotherapy nursing perspectives on the ASC experience. METHODS This is a survey-based study of chemotherapy nursing staff and patients with breast cancer regarding perceived efficacy, side effects, administration, support, and overall opinions of ASC. Chemotherapy nurses across a large, multi-regional tertiary healthcare system completed a one-time survey regarding their experiences in administering ASC. Breast cancer patients who utilized ASC were surveyed along with a control group who underwent alopecia-inducing chemotherapy without ASC use for comparison. RESULTS The majority of nursing responses reported inadequate technical support, an increased burden of administering ASC compared to other clinical duties, and that they would not recommend ASC to a family member or friend. Patients who underwent ASC reported significantly less hair loss and were significantly less likely to shave their heads or wear a wig, but this did not translate into significant differences in body image or psychosocial wellbeing responses. Time investment was the most significant burden related to ASC. CONCLUSION Patients using ASC reported significantly less hair loss compared to those not using ASC during alopecia-inducing breast cancer chemotherapy, but this did not translate to improved body image. The majority of chemotherapy nurses reported they lacked adequate support in administering ASC and would not recommend it. Enhanced nursing support may provide a means for improving the ASC experience for both nursing staff and patients.
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Affiliation(s)
- Benjamin E Ueberroth
- Department of Hematology/Oncology, University of Colorado Anschutz School of Medicine, 12801 E 17thAve, MS, Aurora, CO, 8117, USA.
| | - Heidi E Kosiorek
- Department of Quantitative Health Sciences, Mayo Clinic, Scottsdale, AZ, USA
| | - Nellie N Nafissi
- Department of Hematology/Oncology, University of CA-Irvine, Irvine, CA, USA
| | | | | | - Tufia Haddad
- Mayo Clinic Comprehensive Cancer Center, Rochester, MN, USA
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2
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Weaver D, Pershing ML, Golden B, Hammel L, Russ PK, Cripe M. Retrospective evaluation of Penguin Cold Caps for chemotherapy-induced alopecia. Support Care Cancer 2024; 32:225. [PMID: 38472496 PMCID: PMC10933155 DOI: 10.1007/s00520-024-08393-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 02/16/2024] [Indexed: 03/14/2024]
Abstract
BACKGROUND Scalp cooling is an increasingly recognized non-pharmacologic approach to minimize chemotherapy-induced alopecia (CIA). Several commercially available machine-based and manual scalp cooling systems are available; however, literature reports of effectiveness are highly variable. The purpose of this study was to determine real-world tolerability and subjective effectiveness of a manual cold capping system in minimizing CIA across a variety of patient race and hair types. This study was a single-institution review of outcomes from manual cold capping. METHODS We identified retrospective cohort of adult patients who presented to discuss cold capping between January 14, 2019, and March 31, 2022. Data collected from medical records included demographics, decision to pursue/continue cold capping, diagnoses, chemotherapy regimens, hair characteristics (length, thickness, coarseness, type), and subjective perception of percentage of hair retained. Those with successful vs. unsuccessful cold capping (≥ 50% vs. < 50% of hair retained) were compared based on the patient-level factors of interest. FINDINGS A total of 100 patients initiated cold capping during the study period, and 95% of them completed cold capping. The majority of patients who started cold capping completed it. The median-reported percentage of hair maintained was 75%, and 82/89 (92.1% of patients) had favorable results, defined as ≥ 50% of hair retained. The only patient-level factor associated with favorable response was chemotherapy regimen, with fewer patients receiving doxorubicin-containing regimens having successful hair retention compared to other chemotherapy types (71.4% successful results vs. 95.7% for those receiving paclitaxel-containing regimens and 96.6% for those receiving docetaxel-containing regimens (p = 0.018). There was no difference in success based on patient race/ethnicity or hair characteristics. INTERPRETATION The overall effectiveness (92.1%) in this study is consistent to higher than many literature reports. One possible reason for the high success in our cohort is compliance with cold capping protocols, meaning applying the cap in the appropriate manner and wearing the cap for the prescribed durations, which may impact effectiveness.
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Affiliation(s)
- Dale Weaver
- OhioHealth Cancer Care, 3535 Olentangy River Road Columbus, Columbus, OH, 43214, USA.
| | - Michelle L Pershing
- OhioHealth Research Institute, 3545 Olentangy River Road Columbus, Columbus, OH, 43214, USA
| | - Bethany Golden
- Over My Head, 500 Thomas Lane Columbus, Columbus, OH, 43214, USA
| | - Laura Hammel
- Over My Head, 500 Thomas Lane Columbus, Columbus, OH, 43214, USA
| | - Pauline Kefalas Russ
- OhioHealth Cancer Care, 3430 OhioHealth Parkway Columbus, Columbus, OH, 43202, USA
| | - Mark Cripe
- OhioHealth Breast Surgeons, 285 East State Street, Suite 300, Columbus, OH, 43215, USA
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3
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Heibloem RE, Komen MMC, Ilozumba OUC, van den Hurk CJG. Minimal added value of wetting hair before scalp cooling to prevent chemotherapy-induced alopecia in cancer patients - results from the Dutch Scalp Cooling Registry. Support Care Cancer 2023; 31:273. [PMID: 37067605 DOI: 10.1007/s00520-023-07687-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 03/12/2023] [Indexed: 04/18/2023]
Abstract
PURPOSE Preventing chemotherapy-induced alopecia (CIA) is related to the degree of temperature reduction during scalp cooling. Wetting hair before scalp cooling reduces the scalp skin temperature. This observational study investigated the effects of wetting hair before scalp cooling on preventing CIA and on tolerance in cancer patients. METHODS This Dutch multi-center cohort study comprised 1825 patients receiving ≥1 cycle of docetaxel (D), 5-fluorouracil-epirubicin-cyclophosphamide (FEC), 5-fluorouracil-epirubicin-cyclophosphamide-docetaxel (FECD), paclitaxel (P), or paclitaxel-carboplatin (PC). Patients underwent scalp cooling with wet or dry hair. Primary and secondary outcomes were the effects of wetting hair on head cover use and tolerance, respectively. RESULTS None of the associations between wetting hair and head cover use in patients on D, FEC, P, or PC was significant; however, results all tended to be in favor of wetting hair. For FECD, univariate (p=0.005; OR=1.6; CI=1.1-2.1) and multivariable associations (p=0.007; OR=1.8; CI=1.2-2.6) were significant. Scalp cooling discontinuation due to intolerance differed significantly between groups that wetted hair or not (3% and 1% respectively; p=0.034). CONCLUSION In a large patient group with mainly a European hair type and a high hair mass, no convincing evidence was found whether wetting hair prior to scalp cooling contributes to better prevention of CIA. Since it is argued that a higher reduction in scalp skin temperature by wetting hair contributes positively to scalp cooling efficacy, only a randomized controlled trial can provide an ultimate conclusion at the highest level of evidence. Until that time, healthcare professionals have to take into account that wetting hair may introduce lower compliance to the scalp cooling procedure.
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Affiliation(s)
- Robin E Heibloem
- Department of Health Sciences, Vrije Universiteit Amsterdam, HV 1081, Amsterdam, The Netherlands
| | - Manon M C Komen
- Department of Oncology Research, Northwest Clinics Alkmaar, PO Box 501, AM 1800, Alkmaar, The Netherlands
| | - Onaedo U C Ilozumba
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, United Kingdom
| | - Corina J G van den Hurk
- Comprehensive Cancer Organisation the Netherlands, PO Box 19079, DB 3501, Utrecht, The Netherlands.
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4
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Delgado Rodríguez J, Ramos-García V, Infante-Ventura D, Suarez-Herrera JC, Rueda-Domínguez A, Serrano-Aguilar P, Del Mar Trujillo-Martín M. Ethical, legal, organizational and social issues related to the use of scalp cooling for the prevention of chemotherapy-induced alopecia: A systematic review. Health Expect 2023; 26:567-578. [PMID: 36585793 PMCID: PMC10010082 DOI: 10.1111/hex.13679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 11/15/2022] [Accepted: 11/16/2022] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION Scalp cooling (SC) aims to prevent chemotherapy-induced alopecia. The goal of this systematic review is to tackle ethical, legal, organizational and social issues related to SC. METHODS A critical appraisal of the literature was carried out using a systematic review design. MEDLINE, Embase and Web of Science databases were searched up until 2 June 2021. Studies addressing these aspects in English or Spanish were considered. Representatives of both patient associations and professional scientific societies related to the topic participated in the design of the protocol and the review of the findings. RESULTS A total of 17 studies were included. Articles were critically appraised using the MMAT and SANRA. Findings were organized into four categories: (1) ethical aspects focused on equal access, gender equity and doctor-patient communication supported by Patient Decision Aids (PtDAs); (2) patient perspective and acceptability; (3) professional perspective and acceptability; (4) organizational aspects focused on accessibility and feasibility. CONCLUSION Cancer patients' expectations when using SC need to be adjusted to reduce the potential distress associated with hair loss. PtDAs could help patients clarify their values and preferences regarding SC. Equal access to technology should be guaranteed. PATIENT OR PUBLIC CONTRIBUTION In this systematic review, the representatives of the patient associations (Ms. María Luz Amador Muñoz of the Spanish Association Against Cancer [AECC] and Ms. Catiana Martinez Cánovas of the Spanish Breast Cancer Federation [FECMA]) participated in the review of the study protocol, as well as in the results, discussion and conclusions, making their contributions. In the type of design of these studies (systematic reviews), it is not usual to have the direct participation of patients, but in this one, we have done so, as it is a systematic review that is part of a report of the Spanish Network of Health Technology Assessment Agencies (ETS).
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Affiliation(s)
- Janet Delgado Rodríguez
- Department of Philosophy, University of Granada, Granada, Spain.,The Spanish Network of Agencies for Health Technology Assessment and Services of the National Health System (RedETS), Tenerife, Spain
| | - Vanesa Ramos-García
- The Spanish Network of Agencies for Health Technology Assessment and Services of the National Health System (RedETS), Tenerife, Spain.,Canary Islands Health Research Institute Foundation (FIISC), Tenerife, Spain.,Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Tenerife, Spain
| | - Diego Infante-Ventura
- The Spanish Network of Agencies for Health Technology Assessment and Services of the National Health System (RedETS), Tenerife, Spain.,Canary Islands Health Research Institute Foundation (FIISC), Tenerife, Spain
| | - José Carlos Suarez-Herrera
- The Spanish Network of Agencies for Health Technology Assessment and Services of the National Health System (RedETS), Tenerife, Spain.,Department of Strategy, Entrepreneurship and Sustainable Development KEDGE Business School, Marseille, France.,Cátedra UNITWIN/UNESCO de IPD-SILOS Universidad de Las Palmas de Gran Canaria, Las Palmas, Spain
| | - Antonio Rueda-Domínguez
- Medical Oncology Intercenter Unit, Regional and Virgen de la Victoria University Hospitals, IBIMA, Málaga, Spain.,Research Network on Health Services in Chronic Diseases (REDISSEC), Málaga, Spain
| | - Pedro Serrano-Aguilar
- The Spanish Network of Agencies for Health Technology Assessment and Services of the National Health System (RedETS), Tenerife, Spain.,Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Tenerife, Spain.,Evaluation Unit of the Canary Islands Health Service (SESCS), Tenerife, Spain.,Research Network on Health Services in Chronic Diseases (REDISSEC), Tenerife, Spain
| | - María Del Mar Trujillo-Martín
- The Spanish Network of Agencies for Health Technology Assessment and Services of the National Health System (RedETS), Tenerife, Spain.,Canary Islands Health Research Institute Foundation (FIISC), Tenerife, Spain.,Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Tenerife, Spain.,Research Network on Health Services in Chronic Diseases (REDISSEC), Tenerife, Spain
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5
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Evaluation of Delayed-Type Hypersensitivity to Antineoplastic Drugs-An Overview. Cancers (Basel) 2023; 15:cancers15041208. [PMID: 36831549 PMCID: PMC9954236 DOI: 10.3390/cancers15041208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 01/30/2023] [Accepted: 02/10/2023] [Indexed: 02/17/2023] Open
Abstract
Nowadays, clinical practice encounters the problem of delayed-type hypersensitivity (DTH) induced by several drugs. Antineoplastic treatments are among the drugs which show an elevated proportion of DHT reactions, leading to the worsening of patients' quality of life. The range of symptoms in DHT reactions can vary from mild, such as self-limiting maculopapular eruptions, to severe, such as Stevens-Johnson Syndrome. The development of these reactions supposes a negative impact, not only by limiting patients' quality of life, but also leading to economic loss due to market withdrawal of the affected drugs and high hospitalization costs. However, despite this problem, there are no available standard in vitro or in vivo methods that allow for the evaluation of the sensitizing potential of drugs in the preclinical phase. Therefore, the aim of this review is to summarize the skin reactions caused by the different antineoplastic families, followed by a comprehensive evaluation of the in vitro and in vivo methods used to detect DTHs and that could be suitable to test antineoplastic hypersensitivity reactions.
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6
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Zhang Y, Jimenez JJ. Mild oxidative stress protects against chemotherapy-induced hair loss. Front Oncol 2023; 12:1078916. [PMID: 36703797 PMCID: PMC9872113 DOI: 10.3389/fonc.2022.1078916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 12/20/2022] [Indexed: 01/11/2023] Open
Abstract
Chemotherapy induces hair loss in most cancer patients who undergo treatment, which causes them significant psychosocial trauma. Scalp cooling has demonstrated some efficacy in attenuating chemotherapy-induced alopecia, but response rate varies between patients and chemotherapy class. Here, we showcase in rats a proof-of-concept treatment of using subcutaneous hydrogen peroxide and cumene hydroperoxide injections to provide total protection from hair loss against multiple classes of chemotherapy. We found that subcutaneous peroxides induce cell cycle arrest via P53 activation, thereby protecting hair follicles from the cytotoxic effects of chemotherapy on actively dividing cells. This treatment represents a highly effective and accessible way for cancer patients to maintain quality of life while undergoing treatment for cancer.
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7
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Optimizing treatment management of trastuzumab deruxtecan in clinical practice of breast cancer. ESMO Open 2022; 7:100553. [PMID: 35964548 PMCID: PMC9375150 DOI: 10.1016/j.esmoop.2022.100553] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 06/21/2022] [Accepted: 06/23/2022] [Indexed: 11/22/2022] Open
Abstract
Introduction The antibody-drug conjugate trastuzumab deruxtecan (T-DXd) targets human epidermal growth factor receptor 2 (HER2) and has been evaluated in patients with HER2-positive unresectable/metastatic breast cancer in the phase II DESTINY-Breast01 trial (NCT03248492; DS8201-A-U201) and the randomized phase III DESTINY-Breast03 trial (NCT03529110; DS8201-A-U302). Approximately 20 additional studies are ongoing in breast cancer, including HER2-low breast cancer, and other solid tumor types within the DESTINY trial program. T-DXd has demonstrated a generally manageable safety profile, with low-grade hematologic and gastrointestinal adverse events (AEs) among the most common; interstitial lung disease (ILD)/pneumonitis has been observed in patients receiving T-DXd and can be severe. This review discusses the management of common AEs and AEs of special interest in patients with HER2-positive unresectable/metastatic breast cancer, including nausea and vomiting, neutropenia, infusion-related reactions, alopecia, fatigue, ILD/pneumonitis, and left ventricular dysfunction. Methods Expert opinions, institutional protocols, and strategies to help optimize AE management and maximize the potential benefits of T-DXd in patients with breast cancer from five oncologists treating patients with T-DXd in North America and Europe are discussed. Results Prophylaxis for nausea and vomiting and proactive management of ILD/pneumonitis are especially important in treating patients with T-DXd. Management strategies for other T-DXd-related AEs of interest (e.g. neutropenia, infusion-related reactions, alopecia, fatigue, and left ventricular dysfunction) are also discussed. Conclusions This review provides context for understanding the usage, monitoring, and management practices of other health care providers and institutions with experience using T-DXd to help with safe and effective management of T-DXd-related AEs, particularly since the duration of T-DXd treatment may be quite long. Proper management of T-DXd-related AEs will allow optimal exposure and benefit from T-DXd and will help avoid premature discontinuation or improper dose reductions. Adverse events (AEs) related to trastuzumab deruxtecan (T-DXd) are frequent but most commonly low grade and manageable. Nausea and vomiting are among the most common treatment-emergent AEs. Interstitial lung disease/pneumonitis is an important AE; proactive monitoring, diagnosis, and management are key. Optimizing management of AEs with prophylaxis and effective therapies allows for maximizing the benefit from T-DXd therapy.
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8
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Kolberg-Liedtke C, Lüftner D, Brucker SY, Budach W, Denkert C, Fasching PA, Haidinger R, Harbeck N, Huober J, Jackisch C, Janni W, Krug D, Kühn T, Loibl S, Müller V, Schneeweiss A, Thomssen C, Untch M, Thill M. Practice-Changing Perspectives regarding Systemic Therapy in Early Breast Cancer: Opinions of German Experts regarding the 17th St. Gallen International Consensus Conference. Breast Care (Basel) 2022; 17:336-345. [PMID: 35957945 PMCID: PMC9247526 DOI: 10.1159/000517501] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 05/31/2021] [Indexed: 09/22/2023] Open
Abstract
The general topic of this year's 17th St. Gallen (SG) International Consensus Conference on the treatment of patients with early breast cancer (SG-BCC) was "Customizing local and systemic therapies for women with early breast cancer." This topic considers that each treatment decision must also consider the cancer-specific situation of the individual patient. This year, the votes of the SG-BCC were again discussed taking into account the multidisciplinary German S3 Guidelines and the recommendations of the Breast Cancer Working Group of the AGO (Arbeitsgemeinschaft Gynäkologische Onkologie; AGO Mamma). As the international panel of the SG-BCC consists of experts from different countries, the votes do represent an international cross-section of opinions. Therefore, it is useful to discuss the voting results with respect to the German evidence-based treatment guidelines. This publication focuses mainly on systemic treatment.
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Affiliation(s)
- Cornelia Kolberg-Liedtke
- Clinic for Gynecology and Obstetrics, University Hospital of Essen, Essen, Germany
- Palleos Healthcare GmbH, Wiesbaden, Germany
- Phaon Scientific GmbH, Wiesbaden, Germany
| | - Diana Lüftner
- Medical Clinic Specializing in Hematology, Oncology, and Tumor Immunology, Charité Berlin, Virchow Hospital Campus, Berlin, Germany
| | - Sara Y. Brucker
- Department of Women's Health, University Women's Hospital Tübingen, Tübingen, Germany
| | - Wilfried Budach
- Clinic for Radiation Therapy and Radiation Oncology, University Clinic of Düsseldorf, Düsseldorf, Germany
| | - Carsten Denkert
- Pathology Institute, Philipps University of Marburg and University Hospital of Marburg (UKGM), Marburg, Germany
| | - Peter A. Fasching
- Women's Clinic at the University Hospital of Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | | | - Nadia Harbeck
- Breast Center, Department of OB&GYN and CCC Munich LMU, LMU University Hospital, Munich, Germany
| | - Jens Huober
- Breast Center, Cantonal Hospital of St. Gallen, St. Gallen, Switzerland
| | | | | | - David Krug
- Clinic for Radiation Therapy (Radiation Oncology), University Hospital of Schleswig-Holstein, Kiel Campus, Kiel, Germany
| | - Thorsten Kühn
- Clinic for Gynecology and Obstetrics, Esslingen Hospital, Esslingen, Germany
| | - Sibylle Loibl
- German Breast Group, Neu-Isenburg, Germany
- Bethany Center for Hematology and Oncology, Frankfurt, Germany
| | - Volkmar Müller
- Clinic and Outpatient Clinic for Gynecology, University Clinic of Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Andreas Schneeweiss
- National Center for Tumor Diseases (NCT), University Hospital of Heidelberg (UKHD) and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Christoph Thomssen
- University Clinic and Outpatient Clinic for Gynecology, Martin Luther University of Halle-Wittenberg, Halle (Saale), Germany
| | - Michael Untch
- Clinic for Gynecology and Obstetrics, Interdisciplinary Breast Center, HELIOS Hospital of Berlin-Buch, Berlin, Germany
| | - Marc Thill
- Clinic for Gynecology and Gynecological Oncology, Interdisciplinary Breast Center, Agaplesion Markus Hospital, Frankfurt, Germany
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Lugtenberg RT, van den Hurk CJG, Smorenburg CH, Mosch L, Houtsma D, Deursen MAGDHV, Kaptein AA, Gelderblom H, Kroep JR. Comparable effectiveness of 45- and 20-min post-infusion scalp cooling time in preventing paclitaxel-induced alopecia - a randomized controlled trial. Support Care Cancer 2022; 30:6641-6648. [PMID: 35501515 PMCID: PMC9213299 DOI: 10.1007/s00520-022-07090-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 04/22/2022] [Indexed: 12/01/2022]
Abstract
Purpose
Scalp cooling can prevent chemotherapy-induced alopecia (CIA). Previously, the post-infusion cooling time (PICT) could be successfully reduced in docetaxel-treated patients from 90 to 45 and 20 min. Therefore, it seems plausible that the PICT can be shortened for paclitaxel-treated patients as well. Methods Patients treated with weekly paclitaxel were included in this multi-centre trial and randomly assigned to a PICT of 45 or 20 min. The results were compared to a standard PICT of 90 min, derived from prospective collected data from the Dutch Scalp Cooling Registry. The primary endpoint was the percentage of patients who decide to not wear a wig or head covering. Secondary endpoints were the degree of CIA assessed with the Dean scale for assessment of hair loss; alopecia graded according to NCI CTC toxicity version 4.03 (CTCAE4.03); tolerance of scalp cooling and perceived distress of CIA. Results Ninety-one patients were enrolled in this study; 74 patients were evaluable for hair loss. Hair preservation was successful in 27 patients (75%) with a PICT of 45 min and in 31 patients (82%) with a PICT of 20 min. There was no difference in success rate with the standard PICT of 90 min (85%, p = 0.29). Similar success rates were seen when using the Dean scale and CTCAE assessment, with no differences between groups (p = 0.12 and p = 0.38). Conclusions A 20 min PICT is as effective as 45 and 90 min to prevent weekly paclitaxel-induced alopecia and should be the new standard of care. Trial register
ClinicalTrials.gov Identifier: NCT03266185.
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Affiliation(s)
- Rieneke T Lugtenberg
- Department of Medical Oncology, Leiden University Medical Center, Albinusdreef 2, P.O. Box 9600, Leiden, 2300 RC Leiden, The Netherlands.
| | - Corina J G van den Hurk
- Department of Research & Development, The Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
| | - Carolien H Smorenburg
- Department of Medical Oncology, Antoni Van Leeuwenhoek, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Linda Mosch
- Department of Medical Oncology, Antoni Van Leeuwenhoek, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Danny Houtsma
- Department of Medical Oncology, Haga Hospital, Den Haag, The Netherlands
| | | | - Ad A Kaptein
- Department of Medical Psychology, Leiden University Medical Center, Leiden, The Netherlands
| | - Hans Gelderblom
- Department of Medical Oncology, Leiden University Medical Center, Albinusdreef 2, P.O. Box 9600, Leiden, 2300 RC Leiden, The Netherlands
| | - Judith R Kroep
- Department of Medical Oncology, Leiden University Medical Center, Albinusdreef 2, P.O. Box 9600, Leiden, 2300 RC Leiden, The Netherlands
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10
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Kessler S, Marzooq A, Sood A, Beebe K, Walsh A, Montoya L, Price H. Alopecia in children undergoing chemotherapy, radiation, and hematopoietic stem cell transplantation: Scoping review and approach to management. Pediatr Dermatol 2022; 39:354-362. [PMID: 35416328 DOI: 10.1111/pde.14995] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 03/01/2022] [Accepted: 03/23/2022] [Indexed: 01/07/2023]
Abstract
Alopecia is a common sequela in children undergoing chemotherapy, radiation, and hematopoietic stem cell transplantation. In most cases, this is a transient state in which full hair regrowth eventually occurs, but permanent or persistent alopecia, defined as the presence of incomplete hair regrowth more than 6 months after cessation of treatment, is possible and can be psychologically distressing. We sought to characterize the risk factors that can lead to permanent alopecia following the aforementioned treatments in pediatric populations, as well as diagnostic and treatment options that may be considered, as part of a scoping review of the literature. A general algorithm for approaching these patients was developed based on our findings.
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Affiliation(s)
- Stephen Kessler
- Division of Dermatology, Phoenix Children's Hospital, Phoenix, Arizona, USA.,Alta Dermatology/Phoenix Dermatology/Kansas City University Medical Center, Kansas City, Missouri, USA
| | - Ali Marzooq
- Division of Dermatology, Phoenix Children's Hospital, Phoenix, Arizona, USA.,Alta Dermatology/Phoenix Dermatology/Kansas City University Medical Center, Kansas City, Missouri, USA
| | - Arun Sood
- Division of Dermatology, Phoenix Children's Hospital, Phoenix, Arizona, USA.,Alta Dermatology/Phoenix Dermatology/Kansas City University Medical Center, Kansas City, Missouri, USA
| | - Kristen Beebe
- Phoenix Children's Hospital, Center for Cancer and Blood Disorders, Phoenix, Arizona, USA.,Mayo Clinic Arizona Bone Marrow Transplant Program, Phoenix, Arizona, USA
| | - Alexandra Walsh
- Phoenix Children's Hospital, Center for Cancer and Blood Disorders, Phoenix, Arizona, USA.,The University of Arizona College of Medicine - Phoenix, Phoenix, Arizona, USA
| | - Liliana Montoya
- Division of Dermatology, Phoenix Children's Hospital, Phoenix, Arizona, USA.,The University of Arizona College of Medicine - Phoenix, Phoenix, Arizona, USA
| | - Harper Price
- Division of Dermatology, Phoenix Children's Hospital, Phoenix, Arizona, USA.,The University of Arizona College of Medicine - Phoenix, Phoenix, Arizona, USA
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11
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Amarillo D, De Boni D, Cuello M. [Translated article] Chemotherapy, Alopecia, and Scalp Cooling Systems. ACTAS DERMO-SIFILIOGRAFICAS 2022. [DOI: 10.1016/j.ad.2022.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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12
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Amarillo D, de Boni D, Cuello M. Alopecia, quimioterapia y gorras de frío o «scalp cooling system». ACTAS DERMO-SIFILIOGRAFICAS 2022; 113:278-283. [DOI: 10.1016/j.ad.2021.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 09/12/2021] [Accepted: 09/26/2021] [Indexed: 11/26/2022] Open
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Versluis A, van Alphen K, Dercksen W, de Haas H, van den Hurk C, Kaptein AA. "Dear hair loss"-illness perceptions of female patients with chemotherapy-induced alopecia. Support Care Cancer 2022; 30:3955-3963. [PMID: 35048177 DOI: 10.1007/s00520-021-06748-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 12/07/2021] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Chemotherapy-induced alopecia (CIA) is one of the most common and distressing side effects of chemotherapy treatment. This study aims to assess the illness perceptions of female patients dealing with CIA, and their associations with demographic and clinical characteristics, coping strategies, and quality of life. The secondary aim was to compare the illness perceptions of patients with CIA with other samples, to help elucidate the specific perceptions of patients with CIA. METHOD Forty female patients at risk of severe hair loss due to chemotherapy treatment were included at the oncological daycare unit of a teaching hospital in the Netherlands. Patients were asked to complete the Brief-Illness Perception Questionnaire (B-IPQ) and the Hair Quality of Life (Hair-QoL) questionnaire. RESULTS Illness perceptions indicated that although patients understood their hair loss, they lacked being able to make sense of managing it, negatively impacting patients' lives. Psychological quality of life was significantly correlated with the B-IPQ domains: consequences, degree of concern, and emotional response. Social quality of life was significantly correlated with psychological quality of life. Patients with CIA felt significantly less able to manage their hair loss, compared to patients with breast cancer and psoriatic arthritis. CONCLUSION As patients' beliefs of being able to manage their hair loss are important for adopting and maintaining adequate coping behaviors, additional effort of health care providers in fostering patients' sense of control is indicated, focusing on patients' strengths during and after chemotherapy treatment. In the context of developing interventions for patients with CIA, consequences, concern, and emotional response are the major dimensions that should be taken in account to help patients deal with hair loss.
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Affiliation(s)
- Anne Versluis
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Godebaldkwartier 419, 3511 DT, Utrecht, The Netherlands.
| | - Kirsten van Alphen
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Godebaldkwartier 419, 3511 DT, Utrecht, The Netherlands
| | - Wouter Dercksen
- Department of Medical Oncology, Máxima Medical Centre, Eindhoven, The Netherlands
| | - Henk de Haas
- Department of Medical Oncology, Máxima Medical Centre, Eindhoven, The Netherlands
| | - Corina van den Hurk
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Godebaldkwartier 419, 3511 DT, Utrecht, The Netherlands
| | - Ad A Kaptein
- Department of Medical Psychology, Leiden University Medical Centre, Leiden, The Netherlands
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Renehan S, Tencic M, Jackson K, Krishnasamy M. Improving preparation for scalp cooling: Learning from women undergoing chemotherapy for early-stage breast cancer-The COOL study. J Clin Nurs 2021; 31:3222-3234. [PMID: 34866261 DOI: 10.1111/jocn.16160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 11/12/2021] [Accepted: 11/16/2021] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES This study set out to understand the experiences and expectations of scalp cooling among women with early-stage breast cancer. The objective was to develop patient co-produced information resources to better inform and prepare women considering scalp cooling during chemotherapy. BACKGROUND Treatment-induced alopecia is a common concern among women preparing for chemotherapy. Evidence indicates that many women feel inadequately prepared for scalp cooling, resulting in potentially mitigable distress and disappointment. DESIGN A single-site, sequential, explanatory mixed-methods design was used. Participants included women with early-stage breast cancer who had previously or were currently using, scalp cooling. Women completed an online survey exploring scalp cooling experiences and expectations and self-selecting participants took part in one semi-structured, audio-recorded interview. Guidelines for Good Reporting of a Mixed Methods Study were followed. RESULTS Forty-nine women (69%) consented to take part in the survey and 23 took part in an interview. Most women described losing more hair than they expected. Many described feeling inadequately prepared for the discomfort of scalp cooling; the additional time needed to accommodate scalp cooling during treatment and, that they lacked information about self- care to help minimise hair loss. Importantly, several participants described variability in nurses' knowledge and practical skills regarding scalp cooling. CONCLUSIONS To optimise experience of scalp cooling, women need comprehensive preparatory information about variability in efficacy of scalp cooling; time needed to accommodate scalp cooling; hair care during treatment, and the potential discomfort associated with it. They also need nurses to be confident and well informed about scalp cooling processes. RELEVANCE TO CLINICAL PRACTICE Our study led to the development of online, patient co-produced resources to help prepare and inform women considering using scalp cooling; and an online scalp cooling training module and checklist for nurses. Links to the resources are included in the manuscript.
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Affiliation(s)
- Steffi Renehan
- Academic Nursing Unit, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Department of Nursing, University of Melbourne, Melbourne, Victoria, Australia
| | - Monika Tencic
- Department of Nursing, University of Melbourne, Melbourne, Victoria, Australia
| | - Kylie Jackson
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Meinir Krishnasamy
- Academic Nursing Unit, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, Department of Nursing, University of Melbourne, Melbourne, Victoria, Australia.,Victorian Comprehensive Cancer Centre, Melbourne, Victoria, Australia
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15
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Cancer-Related Alopecia: From Etiologies to Global Management. Cancers (Basel) 2021; 13:cancers13215556. [PMID: 34771716 PMCID: PMC8583126 DOI: 10.3390/cancers13215556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 10/25/2021] [Accepted: 11/03/2021] [Indexed: 11/17/2022] Open
Abstract
Simple Summary Although it does not represent a condition that threatens the life of patients, alopecia nevertheless has an essential impact on the quality of life of patients, particularly in terms of the psychological and social aspects. Indeed, while it has long been considered an acceptable side effect in the management of patients, the progressive emergence of a patient-centered approach coupled with a better knowledge of the pathophysiological processes involved has led to a better consideration of alopecia, both on the preventive and palliative sides. Thus, cancerous alopecia can be multifactorial: iatrogenic (in particular via conventional chemotherapy), induced by a vitamin/nutritional deficiency, or even caused by the disease itself. In this state-of-the-art review, we therefore cover alopecia in an exhaustive manner by considering the different mechanisms involved and their frequency as well as the various therapies offered. Abstract Alopecia represents a multifaceted challenge with distinct etiologies and consequences. Transposed to the world of oncology, different types of alopecia and molecular pathways have been characterized, allowing a better understanding of the underlying mechanisms. In patients with cancer, alopecia can be iatrogenic (i.e., due to conventional chemotherapies, endocrine therapies, targeted therapies, immunotherapies, radiotherapy and surgery) or a direct consequence of the disease itself (e.g., malnutrition, scalp metastases and paraneoplastic syndromes). Identification of the actual incriminated mechanism(s) is therefore essential in order to deliver appropriate supportive care, whether preventive or curative. On the preventive side, the last few years have seen the advent of the automated cooling cap, a prophylactic approach supported by several randomized clinical trials. On the curative side, although the treatments currently available are limited, several promising therapeutic approaches are under development. Appropriate alopecia management is essential, particularly regarding its psychological repercussions with significant consequences on the quality of life of patients and their family and with a potential impact on treatment compliance.
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Novice M, Novice T, Henry NL, Johnson K, Jeruss JS, Kidwell KM, Burness ML. Identifying Barriers and Facilitators to Scalp Cooling Therapy Through a National Survey of the Awareness, Practice Patterns, and Attitudes of Oncologists. JCO Oncol Pract 2021; 18:e225-e234. [PMID: 34529505 DOI: 10.1200/op.21.00273] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
PURPOSE Scalp cooling therapy (SCT) is the most effective method to reduce chemotherapy-induced alopecia (CIA), a highly distressing side effect of cancer treatment. Despite data supporting SCT efficacy and safety, SCT use in the United States is not widespread. Oncologists' interactions with scalp cooling were examined to identify facilitators and barriers to SCT implementation. METHODS A 33-question survey was distributed through the ASCO Research Survey Pool to a nationally representative, random sample of 600 oncology providers. Outcome measures included knowledge of SCT, frequency of initiating conversations about SCT with patients, degree of support, and barriers for SCT. Significance was defined as P < .001. RESULTS Of 155 (25.8%) responding providers, 62% of providers were in favor of SCT always or most of the time, but only 26% reported initiating discussions about SCT always or most of the time. Providers who treat breast cancer (P ≤ .0001), those who report being very familiar with SCT (P ≤ .0001), those who report having read SCT literature in the past 2 years (P ≤ .0001), and those who work at a facility with machine SCT (P ≤ .0001) were significantly more likely to initiate conversations with patients about SCT. Financial concerns (58%) were the primary reason for not recommending SCT use; efficacy (31%), staff or facility (24%), and safety (15%) concerns were also noted. Although safety concerns have decreased markedly over time, 14% of providers report patients who continue to express these concerns and 17% of providers see safety issues as barriers to supporting SCT. CONCLUSION Our findings suggest that oncology provider familiarity and experience with SCT lead to increased support for scalp cooling, which may ultimately result in greater availability and utilization of SCT when indicated.
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Affiliation(s)
| | - Taylor Novice
- Department of Dermatology, Henry Ford Hospital, Detroit, MI
| | - N Lynn Henry
- Department of Internal Medicine, University of Michigan Rogel Cancer Center, Ann Arbor, MI
| | - Kyle Johnson
- Department of Urology, University of Michigan, Ann Arbor, MI
| | | | - Kelley M Kidwell
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI
| | - Monika L Burness
- Department of Internal Medicine, University of Michigan Rogel Cancer Center, Ann Arbor, MI
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Santos TS, Hernandéz Galvis K, Vañó Galván S, Saceda-Corralo D. Post-chemotherapy alopecia: what the dermatologist needs to know. Int J Dermatol 2021; 60:1313-1317. [PMID: 34348414 DOI: 10.1111/ijd.15812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 06/19/2021] [Accepted: 07/02/2021] [Indexed: 11/29/2022]
Abstract
It is estimated that chemotherapy-induced alopecia (CIA) occurs in 65% of chemotherapeutic patients. Forty-seven percent of cancer patients consider hair loss to be the most traumatic aspect of therapy. CIA can be anticipated, depending on the regimen used, and doctors should be aware of the treatments that can minimize it. Careful evaluation before chemotherapy treatment should be performed, and trichoscopy may be useful. Dermatologists do not generally evaluate postchemotherapy alopecia. However, there is an increasing number of reports of permanent chemotherapy-induced alopecia, and these patients require treatment.
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Scalp cooling for reducing alopecia in gynecology oncology patients treated with dose-dense chemotherapy: A pilot project. Gynecol Oncol Rep 2021; 37:100842. [PMID: 34401437 PMCID: PMC8355950 DOI: 10.1016/j.gore.2021.100842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 07/21/2021] [Accepted: 07/22/2021] [Indexed: 12/02/2022] Open
Abstract
Scalp cooling may be of benefit to gynecology oncology patients. Cooling may prevent alopecia induced by Carboplatin and weekly Paclitaxel treatment. For Carboplatin with Paclitaxel every three weeks, alopecia is not prevented.
Objective Determine the efficacy of scalp cooling for the prevention of chemotherapy-induced alopecia in gynecology oncology patients. Methods This prospective pilot study included patients diagnosed with a gynecological malignancy that received DigniCap™ scalp cooling. Patients were divided into two groups based on chemotherapy regimen: Carboplatin with area under the curve (AUC) 5–6 every three weeks and (1) conventional Paclitaxel 175 mg/m2 every three weeks or (2) Paclitaxel 80 mg/m2 weekly. A 1–10 visual analogue scale (1 no hair loss, 10 – complete hair loss) was used to assess degree of hair loss by patients themselves and by a certified dermatologist using photographs. Changes in quality of life and body image were measured using the European Organization for Research and Treatment of Cancer quality of life questionnaire version 3 (EORTC QLQ-C30) and the Body Image Scale (BIS) for cancer patients. Results Hair preservation occurred with use of a scalp cooling device for patients receiving weekly Paclitaxel (n = 20), but not conventional every three weeks Paclitaxel (n = 8). Ten of 15 patients (66.7%) in the dose-dense group lost less than 50% of their hair based on self-assessment and 14 of 16 (87.5%) based on dermatologist assessment. No patient in this group acquired a cranial prosthesis (wig). There was no difference between groups in terms of quality of life (QoL) and BIS scores. Conclusion Scalp cooling may allow for hair preservation in gynecology oncology patients receiving Carboplatin AUC 5–6 and weekly Paclitaxel 80 mg/m2 combination chemotherapy.
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19
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[Alopecia and cancers: From basics to clinical practice]. Bull Cancer 2021; 108:963-980. [PMID: 34304865 DOI: 10.1016/j.bulcan.2021.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 03/30/2021] [Accepted: 04/19/2021] [Indexed: 11/22/2022]
Abstract
Alopecia, although long considered an unavoidable consequence of cancer therapy, currently presents a multifaceted challenge. The knowledge of the physiology of the hair and consequently of the pathophysiology of alopecia has led to show that there is not one but several types of alopecia. Transposed to the world of oncology, different types of alopecia and subsequently molecular pathways have been characterized, allowing a better understanding of the underlying mechanisms. Thus, in patients with cancer, alopecia can be iatrogenic (chemotherapies, endocrine therapies, targeted therapies, immunotherapies, radiotherapy, surgery) or directly the consequence of the disease itself (malnutrition, scalp metastases, paraneoplastic syndromes). Knowledge of the incriminated mechanism(s) could thus make it possible to deploy an appropriate care component, whether on the preventive or curative sides or in terms of supportive care. These are particularly essential regarding the psychological repercussions caused by alopecia, with significant consequences on the quality of life of patients and with a potential impact on treatment compliance. On the preventive side, the last few years have seen the advent of the automated scalp cooling therapy, supported by several randomized clinical trials. On the curative side, several therapeutic proposals are currently deployed or under development in order to provide relevant treatments.
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20
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Untch M, Fasching PA, Brucker SY, Budach W, Denkert C, Haidinger R, Huober J, Jackisch C, Janni W, Kolberg-Liedtke C, Krug D, Kühn T, Loibl S, Lüftner D, Müller V, Schneeweiss A, Thill M, Harbeck N, Thomssen C. Treatment of Patients with Early Breast Cancer: Evidence, Controversies, Consensus: German Expert Opinions on the 17th International St. Gallen Consensus Conference. Geburtshilfe Frauenheilkd 2021; 81:637-653. [PMID: 34168378 PMCID: PMC8216767 DOI: 10.1055/a-1483-2782] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 04/20/2021] [Indexed: 11/10/2022] Open
Abstract
This year's 17th St. Gallen (SG) Consensus Conference on the Treatment of Patients with Early Breast Cancer (SG-BCC) with the title "Customizing local and systemic therapies for women with early breast cancer" focused on the challenge of targeting the treatment of early breast cancer more specifically to the individual disease situation of each patient. As in previous years, a German working group of leading breast cancer experts discussed the results of the international SG-BCC 2021 in the context of the German guideline. It is helpful to compare the SG recommendations with the recently updated treatment recommendations of the Breast Commission of the German Working Group on Gynaecological Oncology (Arbeitsgemeinschaft Gynäkologische Onkologie e. V., AGO) and the S3 guideline because the SG-BCC panel comprised experts from different countries, which is why country-specific aspects can be incorporated into the SG recommendations. The German treatment recommendations of the AGO and the S3 guideline are based on current evidence. Nevertheless, any therapeutic decision must always undergo a risk-benefit analysis for the specific situation and to be discussed with the patient.
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Affiliation(s)
- Michael Untch
- Klinik für Gynäkologie und Geburtshilfe, interdisziplinäres Brustzentrum, HELIOS Klinikum Berlin Buch, Berlin, Germany
| | - Peter A. Fasching
- Frauenklinik des Universitätsklinikums Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | | | - Wilfried Budach
- Klinik für Strahlentherapie und Radioonkologie, Universitätsklinik Düsseldorf, Düsseldorf, Germany
| | - Carsten Denkert
- Pathologisches Institut, Philipps Universität Marburg und Universitätsklinikum Marburg (UKGM), Marburg, Germany
| | | | - Jens Huober
- Brustzentrum Kantonsspital St. Gallen, St. Gallen, Switzerland
- Brustzentrum, Universitätsfrauenklinik Ulm, Ulm, Germany
| | - Christian Jackisch
- Klinik für Gynäkologie und Geburtshilfe, Sana-Klinikum Offenbach GmbH, Offenbach, Germany
| | | | - Cornelia Kolberg-Liedtke
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Essen, Essen, Germany
- palleos healthcare GmbH, Wiesbaden, Germany
- Phaon scientific GmbH, Wiesbaden, Germany
| | - David Krug
- Klinik für Strahlentherapie (Radioonkologie), Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Thorsten Kühn
- Klinik für Frauenheilkunde und Geburtshilfe, Klinikum Esslingen, Esslingen, Germany
| | - Sibylle Loibl
- German Breast Group (GBG), Neu-Isenburg, Germany
- Centrum für Hämatologie und Onkologie Bethanien, Frankfurt am Main, Germany
| | - Diana Lüftner
- Medizinische Klinik mit Schwerpunkt Hämatologie, Onkologie und Tumorimmunologie, Charité Campus Virchow-Klinikum, Berlin, Germany
| | - Volkmar Müller
- Klinik und Poliklinik für Gynäkologie, Universitätsklinik Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Andreas Schneeweiss
- Sektionsleiter Gynäkologische Onkologie, Nationales Centrum für Tumorerkrankungen (NCT) Universitätsklinikum Heidelberg, Heidelberg, Germany
- Deutsches Krebsforschungszentrum (DKFZ), Heidelberg, Germany
| | - Marc Thill
- Klinik für Gynäkologie und Gynäkologische Onkologie, Interdisziplinäres Brustzentrum, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
| | - Nadia Harbeck
- Brustzentrum, Frauenklinik, LMU Klinikum, München, Germany
| | - Christoph Thomssen
- Universitätsklinik und Poliklinik für Gynäkologie, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Germany
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21
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Wang S, Yang T, Shen A, Qiang W, Zhao Z, Zhang F. The scalp cooling therapy for hair loss in breast cancer patients undergoing chemotherapy: a systematic review and meta-analysis. Support Care Cancer 2021; 29:6943-6956. [PMID: 33847828 DOI: 10.1007/s00520-021-06188-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Accepted: 03/28/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE To systematically assess the efficacy and side effects of scalp cooling in patients with breast cancer. METHODS A systematic literature search was conducted in October 2020 across Cochrane Library, PubMed, Embase, CINAHL, Web of Science, Scopus, and four Chinese databases (CNKI, Wanfang, SinoMed, and VIP database). Our review included all randomized controlled trials, cohort studies, and cross-sectional studies. Two authors independently searched databases, screened studies, extracted data, and evaluated each included study's methodological quality and risk bias. Meta-analysis was performed using Stata 15.1 software package and Revman 5.3 software, with estimates of scalp cooling effect and its side effects from pooled using a random-effects model. This study has been registered in the International Prospective Register of Systematic Reviews (PROSPERO, CRD42020216224). RESULTS In total, 755 articles were screened and data from 27 studies involving 2202 participants were used in the meta-analysis. Studies meeting inclusion and exclusion criteria were three randomized clinical trials, 12 cohort studies, and 12 cross-sectional studies. The effectiveness rate of using a scalp cooling device to protect hair was 61% (95% CI: 55 to 67%, I2 = 88%, P = 0.000). However, scalp cooling therapy's side effects are not be ignored, such as headache, dizziness, scalp pain, neck pain, feeling cold, heaviness of the head, skin rash, nausea, and overtightened strap. CONCLUSIONS This review shows that scalp cooling devices can significantly improve the patients with breast cancer chemotherapy-induced alopecia, but the implications of its side effects provide guide for the implementation of this technology.
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Affiliation(s)
- Shurui Wang
- Graduate School, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Ting Yang
- Graduate School, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Aomei Shen
- Nursing Department, National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Wanmin Qiang
- Nursing Department, National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China.
| | - Zihan Zhao
- Nursing Department, National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Fangyuan Zhang
- Nursing Department, National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
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22
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Prospective study of hair recovery after (neo)adjuvant chemotherapy with scalp cooling in Japanese breast cancer patients. Support Care Cancer 2021; 29:6119-6125. [PMID: 33797582 PMCID: PMC8410694 DOI: 10.1007/s00520-021-06168-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 03/18/2021] [Indexed: 10/25/2022]
Abstract
PURPOSE Scalp cooling during chemotherapy infusion to mitigate alopecia for breast cancer patients is becoming widespread; however, studies regarding hair recovery after chemotherapy with scalp cooling are limited. We conducted a prospective study of hair recovery after chemotherapy with scalp cooling. PATIENTS AND METHODS One hundred and seventeen Japanese female breast cancer patients who completed planned (neo)adjuvant chemotherapy using the Paxman Scalp Cooling System for alopecia prevention were evaluated for alopecia prevention in our prospective study. We evaluated their hair recovery 1, 4, 7, 10, and 13 months after chemotherapy. Primary outcomes were grades of alopecia judged by two investigators (objective grades) and patients' answers to the questionnaire regarding the use of a wig or hat (subjective grades). RESULTS Of 117 patients, 75 completed scalp cooling during the planned chemotherapy cycles (Group A), but 42 discontinued it mostly after the first cycle (Group B). Objective and subjective grades were significantly better in Group A than in Group B throughout 1 year, and at 4 and 7 months after chemotherapy. When we restricted patients to those with objective Grade 3 (hair loss of > 50%) at 1 month, Group A exhibited slightly faster hair recovery based on the objective grades than Group B. There was less persistent alopecia in Group A than in Group B. CONCLUSIONS Scalp cooling during chemotherapy infusion for Japanese breast cancer patients increased the rate of hair recovery and had preventive effects against persistent alopecia.
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23
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Anoop TM, Joseph P R, Pn M, Kp P, Gopan G, Chacko S. Cutaneous Toxicities in Breast Cancer Patients Receiving Chemotherapy and Targeted Agents--An Observational Clinical Study. Clin Breast Cancer 2021; 21:e434-e447. [PMID: 33608219 DOI: 10.1016/j.clbc.2021.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 12/17/2020] [Accepted: 01/13/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Systemic chemotherapy and targeted agents are associated with various cutaneous toxicities. Even though cutaneous toxicities are manageable, it often results in treatment discontinuation and worsens the patients' quality of life. AIM The study aimed to determine the spectrum of cutaneous toxicities in patients receiving systemic chemotherapy and targeted agents for breast cancer patients. PATIENTS AND METHODS A total of 250 out of 720 patients with breast cancer who developed various cutaneous toxicities to chemotherapeutic or targeted agents were included in the study. RESULTS Among 250 patients, 57 patients were on neoadjuvant chemotherapy, 89 patients were on adjuvant chemotherapy, 68 were on palliative chemotherapy for metastatic breast cancer and 36 were on targeted treatment for metastatic breast cancer. The most frequently affected site was hair (96%), followed by skin (92%), nail (34%), and mucosa (26%). The most common dermatological toxicity noticed in our study involved the hair in the form of chemotherapy induced alopecia (anagen effluvium) in 93.6%, followed by skin toxicity with generalized xerosis in 92% and, nail toxicity in 34%, and mucosal toxicity in 26%. The most common chemotherapeutic agent which caused frequent cutaneous toxicities in our patients was docetaxel followed by paclitaxel, capecitabine, doxorubicin, epirubicine, cyclophosphamide, 5-flurouracil and targeted agents like lapatinib, everolimus, and tamoxifen. CONCLUSION Cutaneous toxicities are common following systemic chemotherapy and targeted agents. Early recognition of cutaneous side effects of these agents and prompt early interventions can reduce the significant morbidity, cosmetic disfigurement, unnecessary treatment interruptions, and psychological distress in women treated for breast cancers.
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Affiliation(s)
- T M Anoop
- Department of Medical Oncology, Regional Cancer Center, Thiruvananthapuram, Kerala, India.
| | - Rona Joseph P
- Department of Medical Oncology, Regional Cancer Center, Thiruvananthapuram, Kerala, India
| | - Mini Pn
- KIMS Hospital, Thiruvananthapuram, Kerala, India
| | - Pranab Kp
- Department of Medical Oncology, Regional Cancer Center, Thiruvananthapuram, Kerala, India
| | - Gayatri Gopan
- Department of Medical Oncology, Regional Cancer Center, Thiruvananthapuram, Kerala, India
| | - Steffi Chacko
- Department of Medical Oncology, Regional Cancer Center, Thiruvananthapuram, Kerala, India
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24
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Lacouture ME, Sibaud V, Gerber PA, van den Hurk C, Fernández-Peñas P, Santini D, Jahn F, Jordan K. Prevention and management of dermatological toxicities related to anticancer agents: ESMO Clinical Practice Guidelines ☆. Ann Oncol 2021; 32:157-170. [PMID: 33248228 DOI: 10.1016/j.annonc.2020.11.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 11/09/2020] [Indexed: 02/06/2023] Open
Affiliation(s)
- M E Lacouture
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, USA
| | - V Sibaud
- Department of Oncodermatology, Claudius Regaud Institute, Institut Universitaire du Cancer Toulouse Oncopole, Toulouse, France
| | - P A Gerber
- Department of Dermatology, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - C van den Hurk
- Department of Research and Development, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, the Netherlands
| | - P Fernández-Peñas
- Department of Dermatology, The University of Sydney, Westmead Hospital, Sydney, Australia
| | - D Santini
- Arcispedale Santa Maria Nuova di Reggio Emilia, Reggio Emilia, Italy; Department of Medical Oncology, University Campus Bio-Medico, Rome, Italy
| | - F Jahn
- Department of Internal Medicine IV, Hematology, Oncology, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - K Jordan
- Department of Medicine V, Hematology, Oncology and Rheumatology, University Hospital Heidelberg, Heidelberg, Germany
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Boland V, Brady AM, Drury A. The physical, psychological and social experiences of alopecia among women receiving chemotherapy: An integrative literature review. Eur J Oncol Nurs 2020; 49:101840. [PMID: 33120213 DOI: 10.1016/j.ejon.2020.101840] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 09/21/2020] [Accepted: 09/25/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE To conduct an integrative scoping review of the physical, psychological and social experiences of women who have experienced chemotherapy-induced alopecia (CIA). METHOD An integrative review was undertaken. A systematic search of MEDLINE, CINAHL and PsycInfo identified 23 studies meeting the inclusion criteria. Data relating to women's experiences of alopecia was extracted and synthesized thematically. RESULTS Four analytical themes were formed; 'the physical and psychological effect of alopecia', 'more than the loss of hair', 'the complexities of a visual cancer identity' and 'coping with new internal and external relationships'. CIA involves a public and private representation of illness which disrupts women's identity and their acceptance in public, yet this is a highly individualised experience. There is disparity in current evidence regarding the experience of CIA for women among older age groups, with rarer forms of cancer, haematological malignancies and those receiving palliative care or targeted treatment modalities. CONCLUSIONS This review highlights the continued pervasive psychosocial implications arising from CIA, however this is not exclusive to scalp hair as alopecia from the face and body has also been found to require adaptation and effective coping. Limited knowledge exists on the experience of alopecia induced by treatment for haematological cancers and rarer-tumour groups and emerging systemic anti-cancer treatment modalities. Healthcare professionals must endeavour to support and discuss the potential risks of alopecia, and provide patients with an opportunity to voice their fears, concerns, and experiences of CIA. Future research should incorporate the identified underserved populations and the experience of newer therapies.
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Affiliation(s)
- Vanessa Boland
- School of Nursing & Midwifery, Faculty of Health Sciences, Trinity College Dublin, 24 D'Olier Street, Dublin 2, D02 T283, Ireland.
| | - Anne-Marie Brady
- School of Nursing & Midwifery, Faculty of Health Sciences, Trinity College Dublin, 24 D'Olier Street, Dublin 2, D02 T283, Ireland.
| | - Amanda Drury
- School of Nursing & Midwifery, Faculty of Health Sciences, Trinity College Dublin, 24 D'Olier Street, Dublin 2, D02 T283, Ireland; School of Nursing, Midwifery and Health Systems, University College Dublin, Belfield, Dublin 4, Ireland.
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26
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Pedersini R, Fornaro C, di Mauro P, Bianchi S, Vassalli L, Amoroso V, Gelmi M, Ardine M, Rodella F, Cosentini D, Dalla Volta A, Turla A, Pierini M, Motta P, Conti E, Simoncini EL, Berruti A. Efficacy of the DigniCap System in preventing chemotherapy-induced alopecia in breast cancer patients is not related to patient characteristics or side effects of the device. Int J Nurs Pract 2020; 27:e12888. [PMID: 32959460 DOI: 10.1111/ijn.12888] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 06/21/2020] [Accepted: 08/22/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND The DigniCap System is an effective scalp cooling device for the prevention of chemotherapy-induced alopecia in early breast cancer patients. AIM This prospective study was designed to confirm the efficacy and tolerability of the device, to explore potential factors associated with its efficacy and to collect data on patient perceptions and satisfaction. METHODS Between January 2016 and June 2018, 163 early breast cancer patients eligible for adjuvant chemotherapy were enrolled. Hair loss was assessed using the Dean scale, where a score of 0-2 (hair loss ≤50%) was defined as successful. RESULTS Hair preservation was successful in 57% of patients in the overall series. The proportion was even higher (81%) in the patient subgroup treated with a paclitaxel and trastuzumab regimen. Side effects (feeling cold, headache, head heaviness, scalp and cervical pain) were mild to moderate and did not correlate with the rate of hair loss. Lifestyle, anthropometric factors and hair characteristics failed to be associated with device efficacy. CONCLUSIONS The DigniCap System was well tolerated and found to be effective in preventing alopecia in early breast cancer patients. Our study failed to identify factors other than type of chemotherapy regimen associated with hair preservation.
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Affiliation(s)
- Rebecca Pedersini
- Breast Unit-Medical Oncology, ASST Spedali Civili, Brescia, Italy.,Medical Oncology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia at ASST Spedali Civili, Brescia, Italy
| | - Carla Fornaro
- Medical Oncology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia at ASST Spedali Civili, Brescia, Italy
| | - Pierluigi di Mauro
- Medical Oncology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia at ASST Spedali Civili, Brescia, Italy
| | - Susanna Bianchi
- Medical Oncology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia at ASST Spedali Civili, Brescia, Italy
| | - Lucia Vassalli
- Breast Unit-Medical Oncology, ASST Spedali Civili, Brescia, Italy.,Medical Oncology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia at ASST Spedali Civili, Brescia, Italy
| | - Vito Amoroso
- Medical Oncology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia at ASST Spedali Civili, Brescia, Italy
| | - Maria Gelmi
- Medical Oncology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia at ASST Spedali Civili, Brescia, Italy
| | - Mara Ardine
- Medical Oncology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia at ASST Spedali Civili, Brescia, Italy
| | - Filippo Rodella
- Medical Oncology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia at ASST Spedali Civili, Brescia, Italy
| | - Deborah Cosentini
- Medical Oncology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia at ASST Spedali Civili, Brescia, Italy
| | - Alberto Dalla Volta
- Medical Oncology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia at ASST Spedali Civili, Brescia, Italy
| | - Antonella Turla
- Medical Oncology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia at ASST Spedali Civili, Brescia, Italy
| | - Michela Pierini
- Medical Oncology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia at ASST Spedali Civili, Brescia, Italy
| | - Paolo Motta
- Nursing School, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Elisa Conti
- Medical Oncology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia at ASST Spedali Civili, Brescia, Italy
| | | | - Alfredo Berruti
- Medical Oncology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia at ASST Spedali Civili, Brescia, Italy
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Abstract
Drug reactions resulting from chemotherapy agents are common and frequently affect the skin. Although often benign, a select few of these cutaneous reactions may necessitate immediate changes to the antineoplastic regimens. Given the diversity of chemotherapeutic skin reactions and their complex implications on patient management, an organized conceptual schema is imperative for proper patient care. We evaluate a number of commonly seen chemotherapy-induced skin toxicities organized by pathogenic mechanism and drug class, providing a framework for the identification and categorization of adverse events to prevent unrecognition. Groupings of these reactions include direct cytotoxicity and/or drug accumulation, immunologic hypersensitivity, and aberrant molecular signaling.
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Affiliation(s)
- Dylan Haynes
- Department of Dermatology, Oregon Health and Science University, Portland, Oregon, USA
| | - Alex G Ortega-Loayza
- Department of Dermatology, Oregon Health and Science University, Portland, Oregon, USA.
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28
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Silva GDB, Ciccolini K, Donati A, Hurk CVD. Scalp cooling to prevent chemotherapy-induced alopecia. An Bras Dermatol 2020; 95:631-637. [PMID: 32622629 PMCID: PMC7563013 DOI: 10.1016/j.abd.2020.03.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 03/20/2020] [Indexed: 02/07/2023] Open
Abstract
Chemotherapy-induced alopecia causes an important impact on cancer patients and its risk of persistence is currently a considerable issue in cancer survivors. Of the various interventions proposed for the prevention of chemotherapy-induced alopecia, scalp cooling has emerged as an effective and safe strategy. This paper aims to provide an overview on scalp cooling and chemotherapy-induced alopecia prevention.
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Affiliation(s)
| | - Kathryn Ciccolini
- Department of Hematology/Oncology, Mount Sinai Hospital, New York, NY, United States of America
| | - Aline Donati
- Department of Dermatology, Hospital do Servidor Público Municipal de São Paulo, São Paulo, SP, Brazil
| | - Corina van den Hurk
- R & D Department, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
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29
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Hagigeorges D, Burns LJ, Isakoff SJ, Spring L, Nazarian R, Senna MM. Thermal Injury in a Patient Using a Scalp Cooling System to Prevent Chemotherapy-Induced Alopecia. JCO Oncol Pract 2020; 16:522-524. [PMID: 32453655 DOI: 10.1200/op.20.00021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Dina Hagigeorges
- Department of Dermatology, Massachusetts General Hospital, Boston, MA.,Department of Medical Oncology, Massachusetts General Hospital Cancer Center, Boston, MA
| | - Laura J Burns
- Department of Dermatology, Massachusetts General Hospital, Boston, MA.,Harvard Medical School, Boston, MA
| | - Steven J Isakoff
- Department of Medical Oncology, Massachusetts General Hospital Cancer Center, Boston, MA.,Harvard Medical School, Boston, MA
| | - Laura Spring
- Department of Medical Oncology, Massachusetts General Hospital Cancer Center, Boston, MA.,Harvard Medical School, Boston, MA
| | - Rosalynn Nazarian
- Harvard Medical School, Boston, MA.,Department of Pathology, Massachusetts General Hospital, Boston, MA
| | - Maryanne M Senna
- Department of Dermatology, Massachusetts General Hospital, Boston, MA.,Harvard Medical School, Boston, MA
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30
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Ohsumi S, Kiyoto S, Takahashi M, Hara F, Takashima S, Aogi K, Matsuda M, Yamamura N, Doi M. Scalp cooling for hair loss prevention in female Japanese breast cancer patients receiving (neo)adjuvant chemotherapy. Support Care Cancer 2020; 29:437-443. [PMID: 32388615 DOI: 10.1007/s00520-020-05506-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 04/30/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE Scalp cooling during chemotherapy infusion has been recently reported to have moderate efficacy in the mitigation of chemotherapy-induced alopecia; however, there are few reports on Asian patients. We aimed to clarify the effects of scalp cooling in Japanese women. PATIENTS AND METHODS Female Japanese breast cancer patients who planned to receive (neo)adjuvant chemotherapy participated in this prospective study on the efficacy of scalp cooling using the Paxman Scalp Cooling System for alopecia prevention. The primary outcomes were the rates of patients with Grade 3 alopecia (defined as hair loss of > 50%) and the rates of patients who used a wig or hat to conceal hair loss 1 month after the last infusion of chemotherapy. The subjects were given a brief questionnaire regarding headaches, bad mood, fatigue, and chills shortly after each cooling. RESULTS One hundred and forty-three patients participated in the study and used the cooling cap at least once. The mean and median ages of the subjects were 50.6 and 50, respectively (age range 28-76). One hundred and twenty-nine patients completed the planned chemotherapy of 4 to 8 cycles. Among them (7 patients were not evaluable), 74 patients (60.7%) had Grade 3 alopecia 1 month after chemotherapy. Of 80 patients who used the scalp cooling system throughout the planned chemotherapy (1 patient was not evaluable), 36 patients (45.6%) experienced Grade 3 alopecia. CONCLUSION The efficacy of scalp cooling during chemotherapy infusion for hair loss mitigation in Asian women is similar to that in Caucasian women.
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Affiliation(s)
- Shozo Ohsumi
- Department of Breast Oncology, National Hospital Organization Shikoku Cancer Center, 160 Kou, Minami-umemoto-machi, Matsuyama, Ehime, 791-0280, Japan.
| | - Sachiko Kiyoto
- Department of Breast Oncology, National Hospital Organization Shikoku Cancer Center, 160 Kou, Minami-umemoto-machi, Matsuyama, Ehime, 791-0280, Japan
| | - Mina Takahashi
- Department of Breast Oncology, National Hospital Organization Shikoku Cancer Center, 160 Kou, Minami-umemoto-machi, Matsuyama, Ehime, 791-0280, Japan
| | - Fumikata Hara
- Department of Breast Medical Oncology, Breast Oncology Center, Cancer Institute Hospital for JFCR, 3-8-31, Ariake, Koto, Tokyo, 135-8550, Japan
| | - Seiki Takashima
- Department of Breast Oncology, National Hospital Organization Shikoku Cancer Center, 160 Kou, Minami-umemoto-machi, Matsuyama, Ehime, 791-0280, Japan
| | - Kenjiro Aogi
- Department of Breast Oncology, National Hospital Organization Shikoku Cancer Center, 160 Kou, Minami-umemoto-machi, Matsuyama, Ehime, 791-0280, Japan
| | - Miwa Matsuda
- Department of Breast Oncology, National Hospital Organization Shikoku Cancer Center, 160 Kou, Minami-umemoto-machi, Matsuyama, Ehime, 791-0280, Japan
| | - Naomi Yamamura
- Department of Breast Oncology, National Hospital Organization Shikoku Cancer Center, 160 Kou, Minami-umemoto-machi, Matsuyama, Ehime, 791-0280, Japan
| | - Miyuki Doi
- Department of Breast Oncology, National Hospital Organization Shikoku Cancer Center, 160 Kou, Minami-umemoto-machi, Matsuyama, Ehime, 791-0280, Japan
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31
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Management of dermatologic adverse events from cancer therapies: recommendations of an expert panel. An Bras Dermatol 2020; 95:221-237. [PMID: 32165025 PMCID: PMC7175407 DOI: 10.1016/j.abd.2020.01.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Accepted: 01/12/2020] [Indexed: 12/15/2022] Open
Abstract
With the development of new cancer therapies, systemic toxicity profile and effects on survival achieved an important improvement. However, a constellation of toxicities has emerged, even more remarkably, cutaneous adverse events. This report, developed by a board of Brazilian experts in oncodermatology, aims to establish a guideline for the dermatological care of oncologic patients. When possible, evidence-based recommendations were made, but in many cases, when strong evidence was not available, a consensus was reached, based on some data supporting therapies combined with personal experiences.
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32
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Effectiveness and toxicity of second-line actinomycin D in patients with methotrexate-resistant postmolar low-risk gestational trophoblastic neoplasia. Gynecol Oncol 2020; 157:372-378. [PMID: 32037196 DOI: 10.1016/j.ygyno.2020.02.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 01/30/2020] [Accepted: 02/01/2020] [Indexed: 11/23/2022]
Abstract
OBJECTIVES The purpose of this study was to evaluate both the outcomes and toxicity of second-line actinomycin D (ActD) chemotherapy in methotrexate (MTX) - resistant low-risk postmolar gestational trophoblastic neoplasia (GTN) with 5-day ActD versus pulsed ActD. METHODS This retrospective cohort study included patients with MTX-resistant low-risk postmolar GTN from 1974 to 2016. Second-line chemotherapy consisted of 5-day ActD (10-12 μg/kg per day for 5 days every 14 days) or biweekly ActD (1.25 mg/m2 every 2 weeks). Data on patient characteristics, disease presentation, treatment outcome, and toxicity were collected. RESULTS Sixty-eight MTX-resistant patients receiving ActD as second-line chemotherapy were identified (5-day ActD, 53 patients; pulsed ActD, 15 patients). No significant differences were observed in patient/disease characteristics and sustained remission (overall rate 72%) between second-line ActD regimens. Time to hCG remission was significantly faster (median 21 vs 47 days, p = .04) and required fewer treatment cycles (median 1 vs 2, p < .001) with 5-day ActD. Thrombocytopenia was only observed with 5-day ActD (64.6 vs 0%, p < .001). The frequency (60.4 vs 16.7%, p = .009) and severity (grade 3: 37.9 vs 0%, p = .045) of oral mucositis was significantly higher with 5-day ActD. Grade 2 alopecia was significantly more frequent (70.6 vs 16.7%, p = .02) with 5-day ActD. CONCLUSIONS While 5-day ActD and pulsed ActD achieve comparable remission rates, due to its reduced toxicity, ease of administration, and patient convenience, pulsed ActD should be the treatment of choice for MTX-resistant postmolar low-risk GTN.
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33
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Novice T, Novice M, Shapiro J, Lo Sicco K. Chemotherapy-induced alopecia—A potentially preventable side effect with scalp cooling. J Am Acad Dermatol 2020; 82:e57-e59. [DOI: 10.1016/j.jaad.2019.09.059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 09/18/2019] [Indexed: 11/27/2022]
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34
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Giarratano T, Frezzini S, Zanocco M, Giorgi CA, Mioranza E, Miglietta F, Griguolo G, Falci C, Faggioni G, Tasca G, Di Liso E, Vernaci G, Menichetti A, Mantiero M, Grosso D, Guarneri V, Dieci MV. Use of scalp cooling device to prevent alopecia for early breast cancer patients receiving chemotherapy: A prospective study. Breast J 2019; 26:1296-1301. [PMID: 31837103 DOI: 10.1111/tbj.13711] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 11/26/2019] [Accepted: 11/26/2019] [Indexed: 01/31/2023]
Abstract
Chemotherapy-induced alopecia (CIA) affects the majority of patients receiving chemotherapy (CT) for early breast cancer. It is a highly distressing side effect of CT, with psychological and social impact. Primary aim of the present analysis was to assess the efficacy of scalp cooling with DigniCap® in preventing CIA. Success rate was defined as patients' self-reported hair loss <50% according to Dean scale. In this analysis, we reported success rate at 3 weeks after the first CT course and at 3 weeks after the last CT course. Secondary endpoints included self-reported tolerability and patients' judgment on scalp cooling performance. Consecutive early breast cancer patients admitted to Istituto Oncologico Veneto who were recommended to receive neoadjuvant or adjuvant CT, were eligible to undergo scalp cooling during the CT administration within this study. 135 patients were included: 74% received adjuvant CT and 26% neoadjuvant CT (P < .001). The type of CT was: docetaxel-cyclophosphamide (26%), paclitaxel (23%), epirubicin-cyclophosphamide followed by paclitaxel (32%), and paclitaxel followed by epirubicincyclophosphamide (19%). The rate of success in preventing alopecia was 77% (104/135) at 3 weeks from the start of CT and 60% (81/135) at 3 weeks from the end of treatment. Higher success rates were reported in non-anthracycline (71%) compared to anthracycline-containing CT regimens (54%; P < 0.001). Premature discontinuation of scalp cooling was reported in 29/135 patients (21.5%), including withdrawal for alopecia (16/29), for low scalp cooling tolerability (8/29) or both (5/29). Scalp cooling was generally well tolerated. These results overall suggest that the use of scalp cooling is effective in preventing alopecia in the majority of early breast cancer patients receiving neoadjuvant or adjuvant CT, especially for patients undergoing a taxane-based non-anthracycline regimen.
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Affiliation(s)
- Tommaso Giarratano
- Department of Oncology, Unit of Oncology 2, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - Simona Frezzini
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Monica Zanocco
- Nurses Coordinating Center, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - Carlo Alberto Giorgi
- Department of Oncology, Unit of Oncology 2, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - Eleonora Mioranza
- Department of Oncology, Unit of Oncology 2, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - Federica Miglietta
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Gaia Griguolo
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Cristina Falci
- Department of Oncology, Unit of Oncology 2, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - Giovanni Faggioni
- Department of Oncology, Unit of Oncology 2, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - Giulia Tasca
- Department of Oncology, Unit of Oncology 2, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - Elisabetta Di Liso
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Grazia Vernaci
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Alice Menichetti
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Mara Mantiero
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Daniela Grosso
- Nurses Coordinating Center, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - Valentina Guarneri
- Department of Oncology, Unit of Oncology 2, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy.,Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Maria Vittoria Dieci
- Department of Oncology, Unit of Oncology 2, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy.,Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
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35
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Ferreira MN, Ramseier JY, Leventhal JS. Dermatologic conditions in women receiving systemic cancer therapy. Int J Womens Dermatol 2019; 5:285-307. [PMID: 31909148 PMCID: PMC6938835 DOI: 10.1016/j.ijwd.2019.10.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 10/12/2019] [Accepted: 10/13/2019] [Indexed: 12/24/2022] Open
Abstract
As advances in cancer therapies have improved cancer-related survival, novel therapeutics have also introduced a variety of dermatologic toxicities, and an increased number of patients are living with these sequalae. Women with cancer in particular experience a spectrum of dermatologic conditions that affect their skin, hair, nail, and mucosal surfaces. Studies have shown that these toxic effects can significantly affect quality of life and alter a woman's self-image, cultural identity, femininity, sexuality, and mental health. In severe instances, dermatologic toxicities may even disrupt cancer therapy and can therefore affect overall survival and treatment response. In this article, we review the dermatologic adverse effects from traditional chemotherapy, targeted therapy, immune checkpoint inhibitors, and endocrine therapy that disproportionately affect women. The timely diagnosis and management of these dermatologic conditions is crucial in the multidisciplinary care of women with cancer.
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36
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Orlando L, Loparco D, Fedele P, Schiavone P, Quaranta A, Caliolo C, Cinefra M, Rizzo P, Calvani N, Morleo A, Varriano R, Bonuso V, Falcone LL, Caloro M, Cinieri S. Final results of a prospective study of scalp cooling in preventing chemotherapy-induced alopecia. Future Oncol 2019; 15:3337-3344. [PMID: 31578891 DOI: 10.2217/fon-2019-0066] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: Alopecia is a distressing effect of cancer treatments. Our study examined efficacy and safety of scalp cooling to prevent chemotherapy-induced alopecia. Materials & methods: Early breast cancer patients candidate to anthracycline and/or taxane were eligible. Dean's alopecia scale was used to classify alopecia. Results: From February 2016 to November 2018, 127 women were enrolled; 55 (43.3%) received epirubicin/cyclophosphamide (4 EC 3 weeks) followed by paclitaxel (12 P weeks); 50 (39.4%) received 4 EC 3 weeks; 20 (15.7%) received 12 P weeks/trastuzumab and 2 docetaxel/cyclophosphamide (4 TC 3 weeks). The success rate was 71.7% (G0 21.3%, G1 31.5%, G2 18.9%). Frequent side effects were: coldness, headache, scalp pain and head heaviness. Conclusion: In our study, scalp cooling can prevent alopecia thus supporting the wider use in early breast cancer.
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Affiliation(s)
- Laura Orlando
- Medical Oncology Division, Antonio Perrino Hospital, Brindisi, Italy
| | - Dario Loparco
- Medical Oncology Division, Antonio Perrino Hospital, Brindisi, Italy
| | - Palma Fedele
- Medical Oncology Division, Antonio Perrino Hospital, Brindisi, Italy
| | - Paola Schiavone
- Medical Oncology Division, Antonio Perrino Hospital, Brindisi, Italy
| | | | - Chiara Caliolo
- Medical Oncology Division, Antonio Perrino Hospital, Brindisi, Italy
| | | | - Pietro Rizzo
- Medical Oncology Division, Antonio Perrino Hospital, Brindisi, Italy
| | - Nicola Calvani
- Medical Oncology Division, Antonio Perrino Hospital, Brindisi, Italy
| | - Addolorata Morleo
- Medical Oncology Division, Antonio Perrino Hospital, Brindisi, Italy
| | - Rosanna Varriano
- Medical Oncology Division, Antonio Perrino Hospital, Brindisi, Italy
| | - Valentina Bonuso
- Medical Oncology Division, Antonio Perrino Hospital, Brindisi, Italy
| | | | - Manuela Caloro
- Medical Oncology Division, Antonio Perrino Hospital, Brindisi, Italy
| | - Saverio Cinieri
- Medical Oncology Division, Antonio Perrino Hospital, Brindisi, Italy
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37
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Thill M, Jackisch C, Janni W, Müller V, Albert US, Bauerfeind I, Blohmer J, Budach W, Dall P, Diel I, Fasching PA, Fehm T, Friedrich M, Gerber B, Hanf V, Harbeck N, Huober J, Kolberg-Liedtke C, Kreipe HH, Krug D, Kühn T, Kümmel S, Loibl S, Lüftner D, Lux MP, Maass N, Möbus V, Müller-Schimpfle M, Mundhenke C, Nitz U, Rhiem K, Rody A, Schmidt M, Schneeweiss A, Schütz F, Sinn HP, Solbach C, Solomayer EF, Stickeler E, Thomssen C, Untch M, Wenz F, Witzel I, Wöckel A, Ditsch N. AGO Recommendations for the Diagnosis and Treatment of Patients with Locally Advanced and Metastatic Breast Cancer: Update 2019. Breast Care (Basel) 2019; 14:247-255. [PMID: 31558898 DOI: 10.1159/000500999] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 05/16/2019] [Indexed: 12/13/2022] Open
Abstract
Every year the Breast Committee of the Arbeitsgemeinschaft Gynäkologische Onkologie (German Gynecological Oncology Group, AGO), a group of gynecological oncologists specialized in breast cancer and interdisciplinary members specialized in pathology, radiologic diagnostics, medical oncology, and radiation oncology, prepares and updates evidence-based recommendations for the diagnosis and treatment of patients with early and metastatic breast cancer. Every update is performed according to a documented rule-fixed algorithm, by thoroughly reviewing and scoring the recent publications for their scientific validity and clinical relevance. This current publication presents the 2019 update on the recommendations for metastatic breast cancer.
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Affiliation(s)
- Marc Thill
- Klinik für Gynäkologie und Gynäkologische Onkologie, Agaplesion Markus Krankenhaus, Frankfurt/Main, Germany
| | - Christian Jackisch
- Klinik für Gynäkologie und Geburtshilfe, Sana Klinikum Offenbach, Offenbach, Germany
| | - Wolfgang Janni
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Ulm, Ulm, Germany
| | - Volkmar Müller
- Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Ute-Susann Albert
- Klinik für Frauenheilkunde und Geburtshilfe, Klinikum Kassel, Kassel, Germany
| | | | - Jens Blohmer
- Klinik für Gynäkologie mit Brustzentrum der Charité, Berlin, Germany
| | - Wilfried Budach
- Strahlentherapie, Radiologie Düsseldorf, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Peter Dall
- Frauenklinik Städtisches Klinikum Lüneburg, Lüneburg, Germany
| | - Ingo Diel
- Praxisklinik am Rosengarten, Mannheim, Germany
| | | | - Tanja Fehm
- Klinik für Gynäkologie und Geburtshilfe Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Michael Friedrich
- Klinik für Frauenheilkunde und Geburtshilfe Helios Klinikum Krefeld, Krefeld, Germany
| | - Bernd Gerber
- Universitätsfrauenklinik am Klinikum Südstadt, Rostock, Germany
| | - Volker Hanf
- Frauenklinik Nathanstift, Klinikum Fürth, Fürth, Germany
| | - Nadia Harbeck
- Brustzentrum, Klinik für Gynäkologie und Geburtshilfe, Klinikum der Ludwig-Maximilians-Universität, Munich, Germany
| | - Jens Huober
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Ulm, Ulm, Germany
| | | | | | - David Krug
- Klinik für Strahlentherapie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Thorsten Kühn
- Klinik für Frauenheilkunde und Geburtshilfe, Klinikum Esslingen, Esslingen, Germany
| | - Sherko Kümmel
- Klinik für Senologie, Kliniken Essen Mitte, Essen, Germany
| | - Sibylle Loibl
- German Breast Group Forschungs GmbH, Neu-Isenburg, Germany
| | - Diana Lüftner
- Medizinische Klinik mit Schwerpunkt Hämatologie und Onkologie, Charité, Berlin, Germany
| | - Michael Patrick Lux
- Klinik für Gynäkologie und Geburtshilfe, St. Vinzenz-Krankenhaus GmbH Paderborn, Paderborn, Germany
| | - Nicolai Maass
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Volker Möbus
- Klinik für Gynäkologie und Geburtshilfe, Klinikum Frankfurt Höchst GmbH, Frankfurt/Main, Germany
| | - Markus Müller-Schimpfle
- Klinik für Radiologie, Neuroradiologie und Nuklearmedizin, Klinikum Frankfurt Höchst GmbH, Frankfurt/Main, Germany
| | - Christoph Mundhenke
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Ulrike Nitz
- Senologie, Evangelisches Krankenhaus Bethesda, Mönchengladbach, Germany
| | - Kerstin Rhiem
- Zentrum Familiärer Brust- und Eierstockkrebs, Universitätsklinikum Köln, Köln, Germany
| | - Achim Rody
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Marcus Schmidt
- Klinik und Poliklinik für Geburtshilfe und Frauengesundheit der Johannes-Gutenberg-Universität Mainz, Mainz, Germany
| | - Andreas Schneeweiss
- Gynäkologische Onkologie, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Florian Schütz
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Hans-Peter Sinn
- Sektion Gynäkopathologie, Pathologisches Institut, Heidelberg, Germany
| | - Christine Solbach
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Frankfurt, Frankfurt/Main, Germany
| | - Erich-Franz Solomayer
- Klinik für Frauenheilkunde, Geburtshilfe und Reproduktionsmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - Elmar Stickeler
- Klinik für Gynäkologie und Geburtsmedizin, Universitätsklinikum Aachen, Aachen, Germany
| | - Christoph Thomssen
- Universitätsfrauenklinik, Martin-Luther-Universität Halle-Wittenberg, Halle/Saale, Germany
| | | | - Frederik Wenz
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Würzburg, Würzburg, Germany
| | - Isabell Witzel
- Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Achim Wöckel
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Würzburg, Würzburg, Germany
| | - Nina Ditsch
- Brustzentrum, Klinik für Gynäkologie und Geburtshilfe, Klinikum der Ludwig-Maximilians-Universität, Munich, Germany
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Bitto FF, König A, Phan-Brehm T, Vallbracht T, Koch JG, Schinköthe T, Wolfgarten M, Mahner S, Harbeck N, Würstlein R. EVA-Scalp: Evaluation of Patient Satisfaction with a Scalp Cooling Device to Prevent Chemotherapy-Induced Alopecia in Breast Cancer Patients. Breast Care (Basel) 2019; 15:171-177. [PMID: 32398986 DOI: 10.1159/000501393] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 06/06/2019] [Indexed: 01/01/2023] Open
Abstract
Purpose Scalp cooling (SC) offers a chance to reduce hair loss (HL), but patient satisfaction, the effect on well-being, as well as patient selection criteria have not been sufficiently assessed yet. Methods In the EVAScalp trial, SC was offered to 70 breast cancer patients who received chemotherapy between November 2015 and September 2018. For SC, the Paxman-Orbis-II System was used. Satisfaction was measured by a questionnaire evaluating the level of depression with the WHO-5 well-being index (WHO-5) plus questions addressing the patient's experiences and side effects using the SC device. To evaluate efficacy, documentation by photo, by a physician, and by an HL-diary was conducted. Results Regarding efficacy, a significant difference between chemotherapy regimens is seen. Anthracycline-based therapies led to a stop of SC in 71% of the patients, whereas taxane-based therapies without anthracyclines were associated with a high acceptance of SC, and 88% of patients with paclitaxel-based therapies continued SC throughout their chemotherapy. Overall, only 7.69% of the patients stopped because of side effects. As an indicator for quality of life, WHO-5 was higher (65.8%) in patients with successful SC compared to in patients who stopped SC because of HL or side effects (only 53.0%). The majority of patients (82.22%) with successful SC would recommend SC to other patients. Conclusions Patients tolerated SC as long as HL was successfully prevented. The well-being of patients with successful SC was significantly higher than that of patients who stopped SC prematurely. In general, SC is a promising approach and improves patient well-being, but there are still limitations to its utility depending on the chemotherapy regimen used.
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Affiliation(s)
- Franz-Ferdinand Bitto
- Breast Center, Department of Gynecology and Obstetrics and CCC Munich, University of Munich (LMU), Munich, Germany
| | - Alexander König
- Breast Center, Department of Gynecology and Obstetrics and CCC Munich, University of Munich (LMU), Munich, Germany
| | - Thuy Phan-Brehm
- Breast Center, Department of Gynecology and Obstetrics and CCC Munich, University of Munich (LMU), Munich, Germany
| | - Thomas Vallbracht
- Breast Center, Department of Gynecology and Obstetrics and CCC Munich, University of Munich (LMU), Munich, Germany
| | - Julian Gregor Koch
- Breast Center, Department of Gynecology and Obstetrics and CCC Munich, University of Munich (LMU), Munich, Germany
| | - Timo Schinköthe
- Breast Center, Department of Gynecology and Obstetrics and CCC Munich, University of Munich (LMU), Munich, Germany
| | | | - Sven Mahner
- Breast Center, Department of Gynecology and Obstetrics and CCC Munich, University of Munich (LMU), Munich, Germany
| | - Nadia Harbeck
- Breast Center, Department of Gynecology and Obstetrics and CCC Munich, University of Munich (LMU), Munich, Germany
| | - Rachel Würstlein
- Breast Center, Department of Gynecology and Obstetrics and CCC Munich, University of Munich (LMU), Munich, Germany
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Preventing chemotherapy-induced alopecia: a prospective clinical trial on the efficacy and safety of a scalp-cooling system in early breast cancer patients treated with anthracyclines. Br J Cancer 2019; 121:325-331. [PMID: 31303642 PMCID: PMC6738323 DOI: 10.1038/s41416-019-0520-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 06/20/2019] [Indexed: 11/10/2022] Open
Abstract
Background Chemotherapy-induced alopecia (CIA) is a distressing side effect of cancer therapy. The trial aimed to assess feasibility and effectiveness of scalp-cooling system DigniCap® to prevent CIA in primary breast cancer patients receiving an anthracycline containing adjuvant chemotherapy (CT). Methods Hair loss (HL) was evaluated by patient self-assessment and by the physician according to the Dean’s scale at baseline and after each cycle of CT. The primary efficacy endpoint was the patient self-assessment HL score evaluated at least 3 weeks after completing CT. A Dean's scale score of 0–2 (i.e. HL ≤50%) was considered a success. Results From July 2014 to November 2016, 139 consecutive breast cancer patients were enrolled and received at least one treatment with scalp cooling. Fifty-six out of 131 evaluated patients successfully prevented HL (43%, 95% CI: 34–51%). Twenty-four patients (32%) discontinued the scalp cooling because of alopecia or scalp-cooling related AE, three patients had missing information on CIA, and 48 patients (64%) had a HL greater than 50% after CT. No serious AEs were reported. Conclusions DigniCap® System resulted as a promising medical device to be safely integrated in supportive care of early breast cancer patients. Longer follow-up is needed to assess long-term safety and feasibility. Clinical trial registration number NCT03712696.
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Abstract
BACKGROUND Lymphoma patients encounter many problems. Studies investigating the illness experiences of Chinese patients with lymphoma are limited. OBJECTIVE The objectives of this study were to explore the illness experiences of lymphoma patients in China and describe the impacts of this disease on the everyday lives of these individuals. METHODS A descriptive qualitative design was used. The data were collected through face-to-face semistructured interviews and analyzed using the conventional content analysis method. RESULTS Nine men and 7 women participated in this study. The following 6 themes emerged: (1) cancer diagnosis reactions, (2) self-image altered, (3) interpersonal relationships influenced, (4) career development hindered, (5) life philosophy changed, and (6) personal growth achieved. CONCLUSIONS This study contributes new knowledge to the understanding of the illness experiences of lymphoma patients within the Chinese social and cultural context. This study also reveals how these individuals cope with the complex problems they face. IMPLICATIONS FOR PRACTICE Nurses could help Chinese patients with lymphoma accept the disease and its treatments by emphasizing the importance of family integrity. Information, such as how to act in response to workplace discrimination, should be provided to patients by oncology nurses.
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The effect of scalp cooling on CIA-related quality of life in breast cancer patients: a systematic review. Breast Cancer Res Treat 2019; 175:267-276. [DOI: 10.1007/s10549-019-05169-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 02/15/2019] [Indexed: 10/27/2022]
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Gianotti E, Razzini G, Bini M, Crivellaro C, Righi A, Darecchio S, Lui S, Basiricò ML, Cocconi S, Cagossi K, Ferrari A, Artioli F. Scalp Cooling in Daily Clinical Practice for Breast Cancer Patients Undergoing Curative Chemotherapy: A Multicenter Interventional Study. Asia Pac J Oncol Nurs 2019; 6:277-282. [PMID: 31259224 PMCID: PMC6518988 DOI: 10.4103/apjon.apjon_4_19] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Objective: Chemotherapy-induced alopecia is a common and distressful side effect, especially among breast cancer patients. Scalp cooling (SC) can reduce hair loss during anthracycline- and taxane-based chemotherapy. This study assessed the effectiveness of SC in daily clinical practice in three Italian oncology units. Methods: From 2014 to 2016, we prospectively included 220 female early-stage breast cancer patients undergoing curative chemotherapy in combination with SC using the Paxman device. Effectiveness was defined as the severity of hair loss according to the Common Terminology Criteria for Adverse Events Version 4.0 as follows: Grade 0, no hair loss; Grade 1, <50% hair loss not requiring a wig; and Grade 2, ≥50% hair loss at each cycle and at completion of chemotherapy. The tolerability and safety were also evaluated. Results: The overall success rate of SC (hair loss Grade 0–1) was 68%. Severe hair loss was avoided in 89% of women receiving taxane-based chemotherapy and in 78% of women receiving both anthracyclines and taxanes. Among women undergoing anthracycline-based chemotherapy, 47% experienced hair preservation. SC was well tolerated, as only 20 patients discontinued SC for reasons other than hair loss. Conclusions: Our study confirmed that SC provides a reliable chance for breast cancer patients to keep their hair during taxane- and/or anthracycline-based chemotherapy.
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Affiliation(s)
- Emilia Gianotti
- Unit of Medical Oncology, Carpi Civil Hospital, Carpi, Medicine Department, Local Health Unit, Modena, Italy
| | - Giorgia Razzini
- Unit of Medical Oncology, Carpi Civil Hospital, Carpi, Medicine Department, Local Health Unit, Modena, Italy
| | - Manuela Bini
- Unit of Medical Oncology, Carpi Civil Hospital, Carpi, Medicine Department, Local Health Unit, Modena, Italy
| | - Caterina Crivellaro
- Unit of Medical Oncology, Carpi Civil Hospital, Carpi, Medicine Department, Local Health Unit, Modena, Italy
| | - Angela Righi
- Unit of Medical Oncology, Carpi Civil Hospital, Carpi, Medicine Department, Local Health Unit, Modena, Italy
| | - Simona Darecchio
- Oncology Unit, Guastalla Civil Hospital, Guastalla, Medicine Department Local Healt Unit, Reggio Emilia, Italy
| | - Stefania Lui
- Oncology Unit, Guastalla Civil Hospital, Guastalla, Medicine Department Local Healt Unit, Reggio Emilia, Italy
| | | | - Silvia Cocconi
- Oncology Unit, Parma Hospital, University of Parma, Parma, Italy
| | - Katia Cagossi
- Unit of Medical Oncology, Carpi Civil Hospital, Carpi, Medicine Department, Local Health Unit, Modena, Italy
| | - Alessia Ferrari
- Unit of Medical Oncology, Carpi Civil Hospital, Carpi, Medicine Department, Local Health Unit, Modena, Italy
| | - Fabrizio Artioli
- Unit of Medical Oncology, Carpi Civil Hospital, Carpi, Medicine Department, Local Health Unit, Modena, Italy
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Prochilo T, Huscher A, Andreis F, Mirandola M, Zaina E, Pomentale B, Pedrali C, Zanotti L, Mutti S, Zaniboni A. Hair Loss Prevention by a Scalp Cooling Device in Early Breast Cancer Patients: The Poliambulanza Preliminary Experience. Rev Recent Clin Trials 2019; 14:66-71. [PMID: 30457055 DOI: 10.2174/1574887113666181120111104] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 11/08/2018] [Accepted: 11/09/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND The most effective agents in the treatment of breast cancer have a common side effect, the hair loss. Some studies reported a reduction of hair loss with the use of the scalp cooling device. Indeed, it decreases the drug accumulation in the hair follicles. We report our preliminary experience with a scalp cooling device in reducing chemotherapy-induced alopecia and related distress in breast cancer patients undergoing adjuvant chemotherapy. METHODS Hair loss grading and treatment tolerability were evaluated during chemotherapy every 21 days and 3 weeks after the last cycle of chemotherapy via Dean's scale by patients and operators and a comfort analogic scale by patients. We administered the Hospital Anxiety and Depression Scale questionnaire at the baseline and at the end of treatment to assess the distress related to chemotherapy- induced alopecia. RESULTS Among the 46 patients identified, 27 accepted the device. The eligible chemotherapy regimens included docetaxel+cyclophosphamide (TC), doxorubicin+cyclophosphamide (AC) and paclitaxel (P) weekly+trastuzumab (T). 24 pts (89%) completed the treatment; 3 pts (11%) treated with AC prematurely interrupted use of the scalp-cooling device due to inefficacy. After the last cycle of chemotherapy, the number of patient who perceived a HL < grade 2 was 16 (59%). The hair retention reported by operators has been higher (78%). 81.5% of patients well tolerated the treatment. CONCLUSION In our study, the scalp-cooling device reduced chemotherapy-induced alopecia in taxane- based chemotherapy. Furthermore, it suggests a discordance in hair loss perception between patients and operators.
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Affiliation(s)
| | | | | | - Mara Mirandola
- Medical Oncology Unit, Fondazione Poliambulanza, Brescia, Italy
| | | | | | - Chiara Pedrali
- Medical Oncology Unit, Fondazione Poliambulanza, Brescia, Italy
| | - Laura Zanotti
- Medical Oncology Unit, Fondazione Poliambulanza, Brescia, Italy
| | - Stefano Mutti
- Surgery Department, Fondazione Poliambulanza, Brescia, Italy
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van Kalmthout LWM, Lam MGEH, de Keizer B, Krijger GC, Ververs TFT, de Roos R, Braat AJAT. Impact of external cooling with icepacks on 68Ga-PSMA uptake in salivary glands. EJNMMI Res 2018; 8:56. [PMID: 29971556 PMCID: PMC6029992 DOI: 10.1186/s13550-018-0408-2] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 06/06/2018] [Indexed: 12/03/2022] Open
Abstract
Background External cooling of the salivary glands is advised to prevent xerostomia in lutetium-177-PSMA treatment for advanced prostate cancer. Since evidence addressing this subject is sparse, this study aims to determine impact of icepacks application on uptake in salivary glands. Eighty-nine patients referred for gallium-68-PSMA PET/CT for (re)staging of prostate cancer were prospectively included. Twenty-four patients were scanned with unilateral (solely left-sided) icepacks; 20 with bilateral icepacks; 45 without icepacks. Icepacks were applied approximately 30 minutes prior to tracer injection. PET/CT acquisition started 1 hour postinjection. Radiotracer uptake was measured in the parotid- and submandibular glands. Results When comparing the intervention group with the control group, uptake in the left parotid gland significantly differed: SUVmax: 11.07 ± 3.53 versus 12.95 ± 4.16; p = 0.02. SUVpeak: 9.91 ± 3.14 versus 11.45 ± 3.61; p = 0.04. SUVmax and SUVpeak were reduced with 14.52% and 13.45%. All other SUV values did not significantly differ. Patients with bilateral icepacks showed no significant differences in PSMA uptake compared to the control group (all: p > 0.05). Intra-patient analysis revealed some significant differences in SUVmax and SUVpeak between the cooled and non-cooled parotid gland (SUVmax: 11.12 ± 3.71 versus 12.69 ± 3.75; p = 0.00. SUVpeak: 9.93 ± 3.32 versus 11.25 ± 3.25; p = 0.00). Conclusions Impact of icepacks on PSMA uptake seems to be limited to the parotid glands. As clinical relevance of these findings is debatable, structural application of icepacks in the setting of lutetium-177 PSMA therapy needs careful consideration.
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Affiliation(s)
- Ludwike W M van Kalmthout
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, Netherlands.
| | - Marnix G E H Lam
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, Netherlands
| | - Bart de Keizer
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, Netherlands
| | - Gerard C Krijger
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, Netherlands
| | - Tessa F T Ververs
- Department of Clinical Pharmacy, University Medical Center Utrecht, Utrecht, Netherlands
| | - Rememrt de Roos
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, Netherlands
| | - Arthur J A T Braat
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, Netherlands
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Vasconcelos I, Wiesske A, Schoenegg W. Scalp cooling successfully prevents alopecia in breast cancer patients undergoing anthracycline/taxane-based chemotherapy. Breast 2018; 40:1-3. [PMID: 29660543 DOI: 10.1016/j.breast.2018.04.012] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Revised: 04/04/2018] [Accepted: 04/09/2018] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Chemotherapy for breast cancer induces alopecia, representing a major source of patient distress. This study assesses whether a scalp-cooling device is effective in reducing chemotherapy-induced alopecia, and assesses adverse treatment effects. MATERIALS AND METHODS A prospective observational study including women with breast cancer undergoing chemotherapy and scalp cooling using a Paxman device. The primary efficacy end points were: successful hair preservation (no hair loss; <30% hair loss not requiring a wig; or <50% hair loss not requiring a wig) at the completion of chemotherapy. Secondary end points included adverse effects such as headache, pain, nausea or dizziness. RESULTS The study enrolled 131 participants. Mean patient age was 49.8 years; 74% received anthracycline/taxane-based chemotherapy and 26% received taxane-monotherapy based chemotherapy. Hair preservation was successful in 102 women who underwent scalp cooling (71.0%; 95% CI = 63-79%). Only adverse events related to device use were collected, representing 7% (95% CI = 3-11%) of cases. CONCLUSIONS Scalp cooling is effective in preventing hair loss among breast cancer patients undergoing standard chemotherapy treatment, and has minimal adverse effects.
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Affiliation(s)
- Ines Vasconcelos
- Berlin Oncology Center Kurfürstendamm, Kurfürstendamm 216, 10179 Berlin, Germany.
| | - Alexandra Wiesske
- Berlin Oncology Center Kurfürstendamm, Kurfürstendamm 216, 10179 Berlin, Germany
| | - Winfried Schoenegg
- Berlin Oncology Center Kurfürstendamm, Kurfürstendamm 216, 10179 Berlin, Germany
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