1
|
Contreras Molina M, Álvarez Bueno C, Cavero Redondo I, Lucerón Lucas-Torres MI, Jiménez López E, García Maestro A. Effectiveness of Scalp Cooling to Prevent Chemotherapy-Induced Alopecia in Patients Undergoing Breast Cancer Treatment: A Systematic Review and Meta-analysis. Cancer Nurs 2024; 47:319-326. [PMID: 37026981 DOI: 10.1097/ncc.0000000000001234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
Abstract
BACKGROUND Chemotherapy-induced alopecia could cause significant psychological changes, affecting patients' quality of life and their capacity to cope with the disease. OBJECTIVES The aims of this study was to analyze the effectiveness of scalp cooling (SC) to prevent chemotherapy-induced alopecia in patients with breast cancer and to compare the use of automated versus nonautomated therapy delivery devices. METHODS We searched the Cochrane Central Register of Controlled Trials, MEDLINE (through PubMed), Scopus, Web of Science, and ClinicalTrials.gov from their inception to October 2022. A meta-analysis was performed to assess the effects of SC to prevent chemotherapy-induced alopecia in patients with breast cancer using fixed-effects models to calculate the pooled relative risk (RR) and corresponding 95% confidence interval (CI). RESULTS The 8 included studies showed a 43% reduction in the risk of chemotherapy-induced alopecia (RR, 0.57; 95% CI, 0.50-0.64) after the use of SC. Moreover, the use of automated SC devices showed a 47% reduction (RR, 0.53; 95% CI, 0.45-0.60) in the risk of chemotherapy-induced alopecia versus a 43% reduction in the risk of chemotherapy-induced alopecia for nonautomated SC devices (RR, 0.57; 95% CI, 0.44-0.70). CONCLUSION Our results showed that SC significantly reduced the risk of chemotherapy-induced alopecia. IMPLICATIONS FOR PRACTICE Local cold application is a nonpharmacologic therapy that may provide a useful intervention to reduce hair loss and contribute to the psychological well-being of women. Scalp cooling contributes directly to reducing concern about altered body image and to reducing anxiety related to self-concept.
Collapse
Affiliation(s)
- Miguel Contreras Molina
- Author Affiliations: Health Research Department, University de Castilla La Mancha (Drs Álvarez Bueno, Cavero Redondo, and Jiménez López), Cuenca; and Servicio de Salud de Castilla-La Mancha (Mr Contreras Molina, Mrs Lucerón Lucas-Torres, and Mrs García Maestro), Albacete, Spain; Universidad Politécnica y Artística del Paraguay (Dr Álvarez Bueno), Asunción; and Facultad de Ciencias de la Salud, Universidad Autónoma de Chile (Dr Cavero Redondo), Talca
| | | | | | | | | | | |
Collapse
|
2
|
Lambert KA, Albright BB, Anastasio MK, Kaplan SJ, McNally L. Scalp hypothermia to reduce chemotherapy-induced alopecia: A systematic review and meta-analysis. Gynecol Oncol 2024; 188:71-80. [PMID: 38936283 DOI: 10.1016/j.ygyno.2024.06.012] [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: 02/22/2024] [Revised: 06/14/2024] [Accepted: 06/18/2024] [Indexed: 06/29/2024]
Abstract
BACKGROUND Chemotherapy-induced alopecia (CIA) is a common and emotionally-taxing side effect of chemotherapy, including taxane agents used frequently in treatment of gynecologic cancers. Scalp hypothermia, also known as "cold caps", is a possible method to prevent severe CIA, studied primarily in the breast cancer population. OBJECTIVES To compile existing data on scalp hypothermia in cancer patients receiving taxane chemotherapy in order to investigate its application to the gynecologic cancer population. SEARCH STRATEGY MEDLINE, Embase, CINAHL, ClinicalTrials.gov, and Cochrane were searched through January 31, 2023. SELECTION CRITERIA Full-text manuscripts reporting on the results of scalp hypothermia in patients receiving taxane-based chemotherapy. DATA COLLECTION AND ANALYSIS Binomial proportions were summed, and random-effects meta-analyses performed. MAIN RESULTS From 1424 records, we included 31 studies, representing 14 different countries. Only 5 studies included gynecologic cancer patients. We extracted the outcome of the proportion of patients with <50% hair loss. Among 2179 included patients, 60.7% were reported to have <50% hair loss (meta-analysis: 60.6%, 95% confidence interval [CI] 54.9-66.1%). Among the 28 studies reporting only on taxane-based chemotherapy, the rate of <50% hair loss was 60.0% (meta-analysis: 60.9%, (95% CI: 54.9-66.7%). In comparative studies, hair loss was significantly less in patients who received scalp hypothermia versus those who did not (49.3% versus 0% with <50% hair loss; OR 40.3, 95% CI: 10.5-154.8). Scalp cooling achieved <50% hair loss in patients receiving paclitaxel (67.7%; meta-analysis 69.9%, 95% CI 64.1-75.4%) and docetaxel (57.1%; meta-analysis 60.5%, 95% CI 50.0-71.6%). Meta-analysis on patient satisfaction in regard to scalp cooling found a satisfaction rate of 78.9% (95% CI 69.1-87.4%). CONCLUSION Scalp hypothermia may be an effective method to reduce some cases of CIA due to taxane chemotherapy, especially paclitaxel. More trials need to be done to determine the precise effects of scalp hypothermia in gynecologic cancer patients.
Collapse
Affiliation(s)
- Katherine A Lambert
- Duke University, School of Medicine, Durham, NC, United States of America; The Ohio State University, Department of Obstetrics and Gynecology, Columbus, OH, United States of America.
| | - Benjamin B Albright
- University of North Carolina, Department of Obstetrics and Gynecology, Chapel Hill, NC, United States of America
| | | | - Samantha J Kaplan
- Duke University, School of Medicine, Durham, NC, United States of America
| | - Leah McNally
- Duke University, Department of Obstetrics and Gynecology, Durham, NC, United States of America
| |
Collapse
|
3
|
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.
Collapse
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.
| |
Collapse
|
4
|
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.
Collapse
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
| |
Collapse
|
5
|
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.
Collapse
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
| |
Collapse
|
6
|
You JS, Guo L, Huang M, Shi XL, Lin MD, Guo Z, Cao YL, Sun YZ, Xu Q, Qu WL, Liu HL, Chen JP. The effect and mechanism of YH0618 granule on chemotherapy- induced hair loss in patients with breast cancer: study protocol for a randomized, double-blind, multi-center clinical trial. Trials 2019; 20:719. [PMID: 31831051 PMCID: PMC6909490 DOI: 10.1186/s13063-019-3893-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 11/06/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hair loss is one of the most common side effects of chemotherapy, and can cause persistent negative emotions, further affecting therapeutic effects and reducing the quality of life. However, there are no clinically safe and effective methods to solve the problem at present. Our previous clinical and animal studies showed that a medicinal and edible decoction, YH0618, could significantly promote hair growth in cancer patients after chemotherapy, without interfering with the anti-tumor effects of chemotherapy. Besides, the theory of Chinese Medicine believes that the "Essence of the kidney is reflected on the hair". Therefore, this study will further explore the efficacy of YH0618 granule on chemotherapy-induced hair loss in patients with breast cancer by a randomized, double-blind, multi-center clinical trial and elucidate the potential mechanism from the aspect of kidney deficiency or renal dysfunction. METHODS/DESIGN Eligible breast cancer patients who will start chemotherapy will be randomly divided into group A (YH0618 granule) and group B (placebo). The chemotherapeutic agents contain taxanes or/and anthracyclines, and the chemotherapy regimen will be for at least six cycles with a cycle every 3 weeks. Subjects assigned to group A will receive YH0618 granules twice a day (6 g each time), 6 days a week, mixed with 300 ml warm water from the first to the fourth chemotherapy cycle. Subjects in group B will receive the placebo granule in the same manner. The primary outcome is the time point of occurrence of hair loss reaching grade II as assessed by the WHO Toxicity Grading Scale, and objective indices of hair quality and hair-follicle growth recorded by a hair and scalp detector before the fifth chemotherapy cycle. Secondary outcomes include changes of facial color and thumbnail color, grading of thumbnails ridging, assessment of quality life, level of fatigue, routine blood test results, hepatic and renal function, and certain medical indicators which can reflect kidney deficiency in Chinese Medicine. DISCUSSION This research is of great significance for the treatment of cancer and improving the quality of life of cancer patients. The study may provide the most direct evidence for meeting clinical needs and lay a solid scientific foundation for later product development. TRIAL REGISTRATION Chinese Clinical Trial Registry, ID: ChiCTR1800020107. Registered on 14 December 2018.
Collapse
Affiliation(s)
- Jie-shu You
- School of Basic Medical Sciences, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong Province China
- School of Chinese Medicine, The University of Hong Kong, 10 Sassoon Road, Pokfulam, Hong Kong
| | - Li Guo
- Galactophore Department, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, Guangdong Province China
| | - Mei Huang
- Galactophore Department, The First Affiliated Hospital of Guangzhou University of Chinese Medicine Guangzhou, Guangzhou, Guangdong Province China
| | - Xin-lei Shi
- Galactophore Department, The First Affiliated Hospital of Guangzhou University of Chinese Medicine Guangzhou, Guangzhou, Guangdong Province China
| | - Man-di Lin
- Galactophore Department, The First Affiliated Hospital of Guangzhou University of Chinese Medicine Guangzhou, Guangzhou, Guangdong Province China
| | - Zhen Guo
- Galactophore Department, The Third Hospital of Nanchang, Nanchang, Jiangxi Province China
| | - Ya-li Cao
- Galactophore Department, The Third Hospital of Nanchang, Nanchang, Jiangxi Province China
| | - You-zhi Sun
- Basic Medical College, Jiangxi University of Chinese Medicine, Nanchang, Jiangxi Province China
| | - Qian Xu
- School of Basic Medical Sciences, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong Province China
| | - Wei-ling Qu
- School of Basic Medical Sciences, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong Province China
| | - Huan-lan Liu
- School of Basic Medical Sciences, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong Province China
| | - Jian-ping Chen
- School of Chinese Medicine, The University of Hong Kong, 10 Sassoon Road, Pokfulam, Hong Kong
- Shenzhen Institute of Research and Innovation, The University of Hong Kong, Shenzhen, Guangdong Province China
| |
Collapse
|
7
|
Kang D, Kim IR, Park YH, Im YH, Zhao D, Guallar E, Ahn JS, Cho J. Impact of a topical lotion, CG428, on permanent chemotherapy-induced alopecia in breast cancer survivors: a pilot randomized double-blind controlled clinical trial (VOLUME RCT). Support Care Cancer 2019; 28:1829-1837. [DOI: 10.1007/s00520-019-04982-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 07/04/2019] [Indexed: 12/27/2022]
|
8
|
Abstract
Chemotherapy-induced alopecia is a common and distressing adverse effect of many types of chemotherapy. Scalp cooling has been used since the 1970s for prevention of chemotherapy-induced alopecia; however, most data regarding this treatment modality are retrospective in nature, and use in the United States has been limited by safety concerns, specifically the potential for scalp metastases. Two prospective studies of scalp-cooling systems performed in the United States were published within the last year and add evidence supporting the efficacy and safety of scalp cooling in preventing chemotherapy-induced alopecia in patients receiving chemotherapy for solid tumor malignancies. Available data suggest that this technology is most effective for taxane-based chemotherapy regimens compared with anthracycline-based chemotherapy regimens. Two scalp-cooling devices have been cleared by the US Food and Drug Administration, and multiple cold caps are available for patient rental. The adverse effect profile of scalp cooling includes scalp pain, headache, and chills but is tolerable for most patients included in recent clinical trials. Retrospective data suggest that the incidence of scalp metastases related to scalp cooling is low and should not limit use of this technology. Logistic issues related to use of scalp cooling include availability of devices, inconsistent insurance coverage, and incorporation of use into typical infusion center workflow.
Collapse
Affiliation(s)
- Megan Kruse
- Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
| | - Jame Abraham
- Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
| |
Collapse
|
9
|
Huang KL, Lin KY, Huang TW, Loh EW, Hua YM, Su HC, Tam KW. Prophylactic management for taxane-induced nail toxicity: A systematic review and meta-analysis. Eur J Cancer Care (Engl) 2019; 28:e13118. [PMID: 31184794 DOI: 10.1111/ecc.13118] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 03/27/2019] [Accepted: 05/14/2019] [Indexed: 12/27/2022]
Abstract
OBJECTIVE This meta-analysis was performed to assess the efficacy of cryotherapy and nail solution (NS) use in preventing nail toxicity (NT) induced by taxane-based chemotherapy. METHODS PubMed, EMBASE, Cochrane Library and ClinicalTrials.gov registry databases were searched for relevant studies published up to December 2018. The primary outcome was taxane-induced NT. Secondary outcomes were skin toxicity (ST), time to toxicity and patient comfort. RESULTS We reviewed three randomised control trials and six prospective studies with 708 patients. For meta-analysis, taxane-induced NT grading was compared. NT and ST were significantly lower in the cryotherapy patients than in the controls (grade 1 NT: risk ratio [RR] = 0.51, 95% confidence interval [CI] = 0.30-0.89; grade 2-3 NT: RR = 0.36, 95% CI = 0.11-1.12; total NT: RR = 0.49; 95% CI = 0.30-0.79; ST: RR = 0.46, 95% CI = 0.33-0.64). The NS-treated patients exhibited significantly lower NT than the controls. CONCLUSIONS Nail solution-treated or cryotherapy patients exhibited lower NT incidence and severity associated with taxane-based chemotherapy than the controls. For patients who can afford and comply with NS use or cryotherapy, these measures represent effective prophylactic management for taxane-induced NT and improve their quality of life and functional statuses. Further studies are needed to establish the routine usage protocols, long-term efficacy and safety for these interventions.
Collapse
Affiliation(s)
- Kai-Ling Huang
- School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Kuan-Yu Lin
- School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Tsai-Wei Huang
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan.,Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan
| | - El-Wui Loh
- Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan.,Center for Evidence-Based Health Care, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.,Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Yi-Ming Hua
- Department of Pharmacy, Chi Mei Medical Center, Tainan City, Taiwan
| | - Hui-Chen Su
- Department of Pharmacy, Chi Mei Medical Center, Tainan City, Taiwan
| | - Ka-Wai Tam
- Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan.,Center for Evidence-Based Health Care, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.,Division of General Surgery, Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Division of General Surgery, Department of Surgery, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| |
Collapse
|
10
|
Computational Drug Discovery in Chemotherapy-induced Alopecia via Text Mining and Biomedical Databases. Clin Ther 2019; 41:972-980.e8. [PMID: 31030996 DOI: 10.1016/j.clinthera.2019.04.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 03/30/2019] [Accepted: 04/01/2019] [Indexed: 11/20/2022]
Abstract
PURPOSE Chemotherapy-induced alopecia (CIA) is a common and often stressful adverse effect associated with chemotherapy. CIA can cause more psychosocial pressure in patients, including effects on sexuality, self-esteem, and social relationships. We analyzed publicly available data to identify drugs formulated for topical use targeting the relevant CIA molecular pathways by using computational tools. METHODS The genes associated with CIA were determined by text mining, and the gene ontology of the gene set was studied using the Functional Enrichment analysis tool. Protein-protein interaction network analysis was performed using the String database. Enriched gene sets belonging to the identified pathways were queried against the Drug-Gene Interaction database to find drug candidates for topical use in CIA. FINDINGS Our analysis identified 427 genes common to CIA text-mining concepts. Gene enrichment analysis and protein-protein interaction analysis yielded 19 genes potentially targetable by a total of 29 drugs that could possibly be formulated for topical application. IMPLICATIONS The findings from the present analysis would give a new thought to help discover more effective agents, and present tremendous opportunities to study novel target pharmacology and facilitate drug repositioning efforts in the pharmaceutical industry.
Collapse
|
11
|
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.
Collapse
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
| |
Collapse
|
12
|
Marks DH, Qureshi A, Friedman A. Evaluation of Prevention Interventions for Taxane-Induced Dermatologic Adverse Events. JAMA Dermatol 2018; 154:1465-1472. [DOI: 10.1001/jamadermatol.2018.3465] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Dustin H. Marks
- The George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Azam Qureshi
- Department of Dermatology, The George Washington University Medical Faculty Associates, Washington, DC
| | - Adam Friedman
- The George Washington University School of Medicine and Health Sciences, Washington, DC
- Department of Dermatology, The George Washington University Medical Faculty Associates, Washington, DC
| |
Collapse
|
13
|
Martín M, de la Torre-Montero JC, López-Tarruella S, Pinilla K, Casado A, Fernandez S, Jerez Y, Puente J, Palomero I, González Del Val R, Del Monte-Millan M, Massarrah T, Vila C, García-Paredes B, García-Sáenz JA, Lluch A. Persistent major alopecia following adjuvant docetaxel for breast cancer: incidence, characteristics, and prevention with scalp cooling. Breast Cancer Res Treat 2018; 171:627-634. [PMID: 29923063 PMCID: PMC6133184 DOI: 10.1007/s10549-018-4855-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 06/13/2018] [Indexed: 11/29/2022]
Abstract
Background Persistent alopecia (PA) after docetaxel has been recently described. The aim of our study is to establish the incidence and characteristics of PA following adjuvant docetaxel for breast cancer (BC) and to test the ability of scalp cooling in prevention. Patients and methods BC patients receiving adjuvant chemotherapy followed or not by endocrine therapy (and a control group receiving only endocrine therapy) were interviewed in a single institution at 1.5 to 5 years following primary diagnosis searching for PA. A confirmatory prevalence study was later performed in other two institutions. Finally, a prevention study using prophylactic scalp cooling (PSC) with ELASTO-GEL hypothermia caps in patients receiving adjuvant docetaxel was performed. Results In the initial prevalence study (492 patients), minor forms of PA (grade 1) were recorded with all chemotherapy regimens and aromatase inhibitors. Patients receiving docetaxel regimens at cumulative dose (CD) ≥ 400 mmg/m2 presented a significantly higher prevalence of grades 1 PA (33–52%) and 2 PA (5–12%). Prevalence of grade 2 PA with docetaxel CD ≥ 400 mmg/m2 was confirmed in two other institutions. Overall, grade 2 PA was seen in 10.06% (95% CI 7.36–13.61) of 358 patients with docetaxel regimens reaching CD ≥ 400 mmg/m2, but not in patients with lower docetaxel CD, other chemotherapy regimens, or endocrine therapy alone. In prevention trial, no grade 2 PA occurred among 116 patients receiving adjuvant docetaxel (≥ 400 mmg/m2) and PSC followed-up after a 96 months median time. PSC was well tolerated. No scalp relapses were seen among 30 patients (22% of all inclusions) having disease relapse. Conclusion Adjuvant treatment with docetaxel (CD ≥ 400 mmg/m2) is associated with a significant rate of grade 2 PA, leading to wearing a wig, in around 10% of patients. This toxicity was completely prevented with scalp cooling. Clinical Trial Reference: NCT00515762. Electronic supplementary material The online version of this article (10.1007/s10549-018-4855-2) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- M Martín
- Medical Oncology Service, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, CIBERONC, GEICAM, Universidad Complutense, Madrid, Spain. .,Hospital General Universitario Gregorio Marañón, Medical Oncology Service, Calle Maiquez, no. 9, 28007, Madrid, Spain.
| | - J C de la Torre-Montero
- Medical Oncology Department, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), CIBERONC, Madrid, Spain.,Universidad Pontificia Comillas, Madrid, Spain
| | - S López-Tarruella
- Medical Oncology Service, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, CIBERONC, Madrid, Spain
| | - K Pinilla
- Medical Oncology Department, Hospital Clínico Universitario, CIBERONC, Valencia, Spain
| | - A Casado
- Medical Oncology Department, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), CIBERONC, Madrid, Spain
| | - S Fernandez
- Medical Oncology Department, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), CIBERONC, Madrid, Spain.,Medical Oncology Service, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, CIBERONC, Madrid, Spain
| | - Y Jerez
- Medical Oncology Service, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, CIBERONC, Madrid, Spain
| | - J Puente
- Medical Oncology Department, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), CIBERONC, Madrid, Spain
| | - I Palomero
- Medical Oncology Service, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, CIBERONC, Madrid, Spain
| | - R González Del Val
- Medical Oncology Service, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, CIBERONC, Madrid, Spain
| | - M Del Monte-Millan
- Medical Oncology Service, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, CIBERONC, Madrid, Spain
| | - T Massarrah
- Medical Oncology Service, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, CIBERONC, Madrid, Spain
| | - C Vila
- Medical Oncology Department, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), CIBERONC, Madrid, Spain
| | - B García-Paredes
- Medical Oncology Department, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), CIBERONC, Madrid, Spain
| | - J A García-Sáenz
- Medical Oncology Department, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), CIBERONC, Madrid, Spain
| | - A Lluch
- Medical Oncology Department, Hospital Clínico Universitario, CIBERONC, Valencia, Spain
| |
Collapse
|
14
|
Localised Model-Based Active Controlling of Blood Flow During Chemotherapy to Prevent Nail Toxicity and Onycholysis. J Med Biol Eng 2018. [DOI: 10.1007/s40846-018-0416-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
15
|
Freites-Martinez A, Shapiro J, Goldfarb S, Nangia J, Jimenez JJ, Paus R, Lacouture ME. Hair disorders in patients with cancer. J Am Acad Dermatol 2018; 80:1179-1196. [PMID: 29660422 DOI: 10.1016/j.jaad.2018.03.055] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 03/07/2018] [Accepted: 03/18/2018] [Indexed: 01/04/2023]
Abstract
Cytotoxic chemotherapies, molecularly targeted therapies, immunotherapies, radiotherapy, stem cell transplants, and endocrine therapies may lead to hair disorders, including alopecia, hirsutism, hypertrichosis, and pigmentary and textural hair changes. The mechanisms underlying these changes are varied and remain incompletely understood, hampering the development of preventive or therapeutic guidelines. The psychosocial impact of chemotherapy-induced alopecia has been well documented primarily in the oncology literature; however, the effect of other alterations, such as radiation-induced alopecia, hirsutism, and changes in hair color or texture on quality of life have not been described. This article reviews clinically significant therapy-related hair disorders in oncology patients, including the underlying pathophysiological mechanisms, severity grading scales, patient-reported quality of life questionnaires, management strategies, and future translational research opportunities.
Collapse
Affiliation(s)
- Azael Freites-Martinez
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jerry Shapiro
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York
| | - Shari Goldfarb
- Breast Cancer Medicine Service, Department of Medicine, Division of Solid Tumor Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Julie Nangia
- Lester and Sue Smith Breast Center, Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, Texas
| | - Joaquin J Jimenez
- Department of Dermatology and Cutaneous Surgery, Miller School of Medicine, University of Miami, Miami, Florida; Department of Biochemistry and Molecular Biology, Miller School of Medicine, University of Miami, Miami, Florida
| | - Ralf Paus
- Dermatology Research Centre, University of Manchester, Manchester, United Kingdom; National Institute of Health Research Manchester Biomedical Research Centre, Manchester, United Kingdom; Department of Dermatology, University of Munster, Munster, Germany
| | - Mario E Lacouture
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.
| |
Collapse
|
16
|
Onaolapo A, Adebayo A, Onaolapo O. Oral phenytoin protects against experimental cyclophosphamide-chemotherapy induced hair loss. PATHOPHYSIOLOGY 2018; 25:31-39. [DOI: 10.1016/j.pathophys.2017.12.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 11/25/2017] [Accepted: 12/01/2017] [Indexed: 12/19/2022] Open
|
17
|
Rugo HS, Voigt J. Scalp Hypothermia for Preventing Alopecia During Chemotherapy. A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Clin Breast Cancer 2018; 18:19-28. [DOI: 10.1016/j.clbc.2017.07.012] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 04/04/2017] [Accepted: 07/16/2017] [Indexed: 11/16/2022]
|
18
|
Auvinen PK, Mähönen UA, Soininen KM, Paananen PK, Ranta-Koponen PH, Saavalainen IE, Johansson RT. The Effectiveness of a Scalp Cooling Cap in Preventing Chemotherapy-Induced Alopecia. TUMORI JOURNAL 2018; 96:271-5. [DOI: 10.1177/030089161009600214] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aims and background Hair loss is one of the most unpleasant side effects associated with chemotherapy treatments. It causes emotional disturbances and constantly reminds the patient of the disease. This study analyzed the effectiveness of scalp cooling caps in preventing alopecia among 64 patients. Methods The patients were given one of the following chemotherapeutic treatments: doxorubicin 60 mg/m2, docetaxel 80 mg/m2, FEC (5-fluorouracil 600 mg/m2, epirubicin 60 mg/m2, cyclophosphamide 600 mg/m2) or the combination of three cycles of docetaxel (80 mg/m2) followed by three cycles of FEC (5-fluorouracil 600 mg/m2, epirubicin 60 mg/m2, cyclophosphamide 600 mg/m2). All the chemotherapy treatments were given in a three-weekly schedule. Patients with early stage disease were given six adjuvant chemotherapy cycles, while patients with metastatic disease were given nine chemotherapy cycles. The patients were provided with detailed instructions on how to treat the hair at home for one to three days after the chemotherapy treatment. Hair loss was evaluated after the third, sixth and final treatments. Results In the final results, major hair loss was avoided in all patients given doxorubicin treatment, in 83.3% of patients given docetaxel treatment, in 76.5% of patients given FEC treatment, and in 78% of patients given docetaxel followed by FEC. In the final evaluation, 87.5% of the patients considered the avoidance of hair loss to be important. Only 20.3% of the patients needed to use a wig. Conclusions This study shows that all the patient groups studied gained some benefit by using scalp cooling caps.
Collapse
|
19
|
Shah VV, Wikramanayake TC, DelCanto GM, van den Hurk C, Wu S, Lacouture ME, Jimenez JJ. Scalp hypothermia as a preventative measure for chemotherapy-induced alopecia: a review of controlled clinical trials. J Eur Acad Dermatol Venereol 2017; 32:720-734. [PMID: 28976026 DOI: 10.1111/jdv.14612] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 08/14/2017] [Indexed: 11/26/2022]
Abstract
Chemotherapy-induced alopecia (CIA) is a temporary, yet psychologically devastating form of hair loss that affects 65% of patients receiving cancer chemotherapy. In the 1970s, scalp hypothermia was introduced as a preventative measure against the development of CIA. Numerous studies provide evidence for the effectiveness of scalp cooling to prevent CIA, although results varied because of differences in chemotherapy regimen, cooling technique, mode of administration and patient factors. However, many of the existing studies are uncontrolled or consist of small sample sizes, and data from randomized, randomized studies are limited. To date, no clear guidelines have been established for optimum scalp cooling use as a treatment modality and its efficacy remain unknown. Nonetheless, scalp cooling remains the most widely utilized method for the prevention of CIA, and in December 2015, the United States Food and Drug Administration (FDA) cleared the DigniCap® Scalp Cooling System (Dignitana AB, Sweden) for marketing and the Orbis from Paxman® Coolers Ltd. received clearance in 2017. This literature review is one of the first to provide up-to-date review and side-by-side comparisons of controlled and randomized clinical trials (CCTs and RCTs) evaluating scalp hypothermia for the prevention of CIA. Our analyses of CCTs and RCTs to date show that scalp hypothermia is effective in reducing the occurrence rate of CIA, by 2.7-fold in the CCTs and 3.9-fold in the RCTs. These results suggest that scalp hypothermia represents an effective preventative measure for CIA, and provide guidance for management of anticipated alopecia following chemotherapy and for future investigations.
Collapse
Affiliation(s)
- V V Shah
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - T C Wikramanayake
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - G M DelCanto
- Department of Biochemistry and Molecular Biology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - C van den Hurk
- Research Department, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands
| | - S Wu
- Department of Medicine, Stony Brook, Stony Brook, NY, USA
| | - M E Lacouture
- Department of Medicine, Dermatology Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - J J Jimenez
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA.,Department of Biochemistry and Molecular Biology, University of Miami Miller School of Medicine, Miami, FL, USA
| |
Collapse
|
20
|
Dunnill CJ, Al-Tameemi W, Collett A, Haslam IS, Georgopoulos NT. A Clinical and Biological Guide for Understanding Chemotherapy-Induced Alopecia and Its Prevention. Oncologist 2017; 23:84-96. [PMID: 28951499 DOI: 10.1634/theoncologist.2017-0263] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Accepted: 08/17/2017] [Indexed: 12/11/2022] Open
Abstract
Chemotherapy-induced alopecia (CIA) is the most visibly distressing side effect of commonly administered chemotherapeutic agents. Because psychological health has huge relevance to lifestyle, diet, and self-esteem, it is important for clinicians to fully appreciate the psychological burden that CIA can place on patients. Here, for the first time to our knowledge, we provide a comprehensive review encompassing the molecular characteristics of the human hair follicle (HF), how different anticancer agents damage the HF to cause CIA, and subsequent HF pathophysiology, and we assess known and emerging prevention modalities that have aimed to reduce or prevent CIA. We argue that, at present, scalp cooling is the only safe and U.S. Food and Drug Administration-cleared modality available, and we highlight the extensive available clinical and experimental (biological) evidence for its efficacy. The likelihood of a patient that uses scalp cooling during chemotherapy maintaining enough hair to not require a wig is approximately 50%. This is despite different types of chemotherapy regimens, patient-specific differences, and possible lack of staff experience in effectively delivering scalp cooling. The increased use of scalp cooling and an understanding of how to deliver it most effectively to patients has enormous potential to ease the psychological burden of CIA, until other, more efficacious, equally safe treatments become available. IMPLICATIONS FOR PRACTICE Chemotherapy-induced alopecia (CIA) represents perhaps the most distressing side effect of chemotherapeutic agents and is of huge concern to the majority of patients. Scalp cooling is currently the only safe option to combat CIA. Clinical and biological evidence suggests improvements can be made, including efficacy in delivering adequately low temperature to the scalp and patient-specific cap design. The increased use of scalp cooling, an understanding of how to deliver it most effectively, and biological evidence-based approaches to improve its efficacy have enormous potential to ease the psychological burden of CIA, as this could lead to improvements in treatment and patient quality-of-life.
Collapse
Affiliation(s)
- Christopher John Dunnill
- Department of Biological Sciences, School of Applied Sciences, University of Huddersfield, Huddersfield, United Kingdom
- Institute of Skin Integrity and Infection Prevention, University of Huddersfield, Huddersfield, United Kingdom
| | - Wafaa Al-Tameemi
- Department of Biological Sciences, School of Applied Sciences, University of Huddersfield, Huddersfield, United Kingdom
| | - Andrew Collett
- Department of Biological Sciences, School of Applied Sciences, University of Huddersfield, Huddersfield, United Kingdom
- Institute of Skin Integrity and Infection Prevention, University of Huddersfield, Huddersfield, United Kingdom
| | - Iain Stuart Haslam
- Department of Biological Sciences, School of Applied Sciences, University of Huddersfield, Huddersfield, United Kingdom
- Institute of Skin Integrity and Infection Prevention, University of Huddersfield, Huddersfield, United Kingdom
| | - Nikolaos Theodoros Georgopoulos
- Department of Biological Sciences, School of Applied Sciences, University of Huddersfield, Huddersfield, United Kingdom
- Institute of Skin Integrity and Infection Prevention, University of Huddersfield, Huddersfield, United Kingdom
| |
Collapse
|
21
|
Fehr MK, Welter J, Sell W, Jung R, Felberbaum R. Sensor-controlled scalp cooling to prevent chemotherapy-induced alopecia in female cancer patients. ACTA ACUST UNITED AC 2016; 23:e576-e582. [PMID: 28050147 DOI: 10.3747/co.23.3200] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Scalp cooling has been used since the 1970s to prevent chemotherapy-induced alopecia, one of the most common and psychologically troubling side effects of chemotherapy. Currently available scalp cooling systems demonstrate varying results in terms of effectiveness and tolerability. METHODS For the present prospective study, 55 women receiving neoadjuvant, adjuvant, or palliative chemotherapy were enrolled. The aim was to assess the effectiveness of a sensor-controlled scalp cooling system (DigniCap: Sysmex Europe GmbH, Norderstedt, Germany) to prevent chemotherapy-induced alopecia in breast or gynecologic cancer patients receiving 1 of 7 regimens. Clinical assessments, satisfaction questionnaires, and alopecia evaluations [World Health Organization (who) grading for toxicity] were completed at baseline, at each cycle, and at completion of chemotherapy. RESULTS Of the 55 patients, 78% underwent scalp cooling until completion of chemotherapy. In multivariate analysis, younger women and those receiving paclitaxel weekly or paclitaxel-carboplatin experienced less alopecia. The compound successful outcome ("no head covering" plus "who grade 0/1") was observed in all patients 50 years of age and younger receiving 4 cycles of docetaxel-cyclophosphamide or 6 cycles of paclitaxel-carboplatin. Conversely, alopecia was experienced by all women receiving triplet polychemotherapy (6 cycles of docetaxel-doxorubicin-cyclophosphamide). For women receiving sequential polychemotherapy regimens (3 cycles of fluorouracil-epirubicin-cyclophosphamide followed by 3 cycles of docetaxel or 4 cycles of doxorubicin-cyclophosphamide followed by 4 cycles of docetaxel), the subgroup 50 years of age and younger experienced a 43% success rate compared with a 10% rate for the subgroup pf older women receiving the same regimens. CONCLUSIONS The ability of scalp cooling to prevent chemotherapy-induced alopecia varies with the chemotherapy regimen and the age of the patient. Use of a compound endpoint with subjective and objective measures provides insightful and practical information when counselling patients.
Collapse
Affiliation(s)
- M K Fehr
- Department of Obstetrics and Gynecology, Cantonal Hospital Frauenfeld, Switzerland
| | - J Welter
- Department of Obstetrics and Gynecology, Cantonal Hospital Frauenfeld, Switzerland
| | - W Sell
- Department of Obstetrics and Gynecology, Cantonal Hospital Frauenfeld, Switzerland
| | - R Jung
- Department of Obstetrics and Gynecology, Cantonal Hospital Frauenfeld, Switzerland
| | - R Felberbaum
- Department of Obstetrics and Gynecology, Clinic of Kempten-Oberallgäu, Germany
| |
Collapse
|
22
|
Belum VR, de Barros Silva G, Laloni MT, Ciccolini K, Goldfarb SB, Norton L, Sklarin NT, Lacouture ME. Cold thermal injury from cold caps used for the prevention of chemotherapy-induced alopecia. Breast Cancer Res Treat 2016; 157:395-400. [PMID: 27146710 DOI: 10.1007/s10549-016-3799-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 04/15/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION The use of scalp cooling for the prevention of chemotherapy-induced alopecia (CIA) is increasing. Cold caps are placed onto the hair-bearing areas of the scalp for varying time periods before, during, and after cytotoxic chemotherapy. Although not yet reported, improper application procedures could result in adverse events (AEs). At present, there are no evidence-based scalp cooling protocols, and there is no regulatory oversight of their use. OBJECTIVE To report the occurrence of cold thermal injury (frostbite) on the scalp, following the use of cold caps for the prevention of CIA. MATERIALS AND METHODS We identified four patients who developed cold thermal injuries on the scalp following the application of cold caps. Medical records were analyzed to retrieve the demographic and clinical characteristics. RESULTS The cold thermal injuries in our patients were grade 1/2 in severity and improved with topical interventions and interruption of cold cap use, although grade 1 persistent alopecia ensued in 3 patients. The true incidence of such injuries in this setting, however, remains unknown. CONCLUSIONS Cold thermal injuries are likely infrequent and preventable AEs that may result from improper device application procedures during cold cap use. Although these untoward events are usually mild to moderate in severity, the potential occurrence of long-term sequelae (e.g., permanent alopecia and scarring) or the need to discontinue cold cap use, are not known. Prospective studies are needed to further elucidate the risk and standardize healthcare delivery methods, and to improve patient/supportive/healthcare provider education.
Collapse
Affiliation(s)
- Viswanath Reddy Belum
- Dermatology Service, Memorial Sloan Kettering Cancer Center, 60th Street Outpatient Center, 16 East 60th St., Suite 407, Room 4312, New York, NY, USA
| | | | | | - Kathryn Ciccolini
- Dermatology Service, Memorial Sloan Kettering Cancer Center, 60th Street Outpatient Center, 16 East 60th St., Suite 407, Room 4312, New York, NY, USA
| | - Shari B Goldfarb
- Breast Medicine Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Larry Norton
- Breast Medicine Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Nancy T Sklarin
- Breast Medicine Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Mario E Lacouture
- Dermatology Service, Memorial Sloan Kettering Cancer Center, 60th Street Outpatient Center, 16 East 60th St., Suite 407, Room 4312, New York, NY, USA.
| |
Collapse
|
23
|
Sahadevan SWD, Ding SR, Del Priore G. Hair "regrowth" during chemotherapy after scalp cooling technique. Int J Dermatol 2016; 55:e463-5. [PMID: 26991069 DOI: 10.1111/ijd.13261] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 11/13/2015] [Accepted: 11/17/2015] [Indexed: 11/28/2022]
|
24
|
Results of 20- versus 45-min post-infusion scalp cooling time in the prevention of docetaxel-induced alopecia. Support Care Cancer 2016; 24:2735-41. [DOI: 10.1007/s00520-016-3084-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 01/14/2016] [Indexed: 10/22/2022]
|
25
|
Shin H, Jo SJ, Kim DH, Kwon O, Myung SK. Efficacy of interventions for prevention of chemotherapy-induced alopecia: a systematic review and meta-analysis. Int J Cancer 2014; 136:E442-54. [PMID: 25081068 DOI: 10.1002/ijc.29115] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Accepted: 07/09/2014] [Indexed: 11/10/2022]
Abstract
Chemotherapy-induced alopecia (CIA) is a highly distressing event for cancer patients, and hence, we here aimed to assess the efficacy of various interventions in the prevention of CIA. We searched PubMed, EMBASE and the Cochrane Library, from June 20, 2013 through August 31, 2013. Two of the authors independently reviewed and selected clinical trials that reported the efficacy of any intervention for prevention of CIA compared with that of controls. Two authors extracted data independently on dichotomized outcome in terms of CIA occurrence. Relative risks (RRs) and 95% confidential intervals (CIs) were calculated for efficacy of CIA prevention by using random-effect or fixed-effect models. Out of 691 articles retrieved, a total of eight randomized controlled trials and nine controlled clinical trials involving 1,098 participants (616 interventions and 482 controls), were included in the final analyses. Scalp cooling, scalp compression, a combination of cooling and compression, topical minoxidil and Panicum miliaceum were used as interventions. The participants were mainly breast cancer patients receiving doxorubicin- or epirubicin-containing chemotherapy. Scalp cooling, which is the most popular preventive method, significantly reduced the risk of CIA (RR = 0.38, 95% CI = 0.32-0.45), whereas topical 2% minoxidil and other interventions did not significantly reduce the risk of CIA. No serious adverse effects associated with scalp cooling were reported. Our results suggest that scalp cooling can prevent CIA in patients receiving chemotherapy. However, the long-term safety of scalp cooling should be confirmed in further studies.
Collapse
Affiliation(s)
- Hyoseung Shin
- Department of Dermatology, Dongguk University Ilsan Hospital, Goyang, Korea
| | | | | | | | | |
Collapse
|
26
|
Treatment and prevention of chemotherapy-induced alopecia with PTH-CBD, a collagen-targeted parathyroid hormone analog, in a non-depilated mouse model. Anticancer Drugs 2014; 25:30-8. [PMID: 24025564 DOI: 10.1097/cad.0b013e3283650bff] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Alopecia is a psychologically devastating complication of chemotherapy for which there is currently no effective therapy. PTH-CBD is a collagen-targeted parathyroid hormone analog that has shown promise as a therapy for alopecia disorders. This study compared the efficacy of prophylactic versus therapeutic administration of PTH-CBD in chemotherapy-induced alopecia using a mouse model that mimics the cyclic chemotherapy dosing used clinically. C57BL/6J mice were treated with a single subcutaneous injection of PTH-CBD (320 mcg/kg) or vehicle control before or after hair loss developing from three courses of cyclophosphamide chemotherapy (50-150 mg/kg/week). Mice receiving chemotherapy alone developed hair loss and depigmentation over 6-12 months. Mice pretreated with PTH-CBD did not develop these changes and maintained a normal-appearing coat. Mice treated with PTH-CBD after development of hair loss showed a partial recovery. Observations of hair loss were confirmed quantitatively by gray scale analysis. Histological examination showed that in mice receiving chemotherapy alone, there were small, dystrophic hair follicles mostly in the catagen phase. Mice receiving PTH-CBD before chemotherapy showed a mix of normal-appearing telogen and anagen hair follicles with no evidence of dystrophy. Mice receiving PTH-CBD therapy after chemotherapy showed intermediate histological features. PTH-CBD was effective in both the prevention and the treatment of chemotherapy-induced alopecia in mice, but pretreatment appears to result in a better cosmetic outcome. PTH-CBD shows promise as an agent in the prevention of this complication of chemotherapy and improving the quality of life for cancer patients.
Collapse
|
27
|
Kadakia KC, Rozell SA, Butala AA, Loprinzi CL. Supportive cryotherapy: a review from head to toe. J Pain Symptom Manage 2014; 47:1100-15. [PMID: 24210702 PMCID: PMC4013268 DOI: 10.1016/j.jpainsymman.2013.07.014] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2013] [Revised: 07/17/2013] [Accepted: 07/23/2013] [Indexed: 11/26/2022]
Abstract
CONTEXT Conventional chemotherapy leads to multiple adverse mucocutaneous complications such as oral mucositis, alopecia, ocular toxicity, and onycholysis. Limited pharmacologic interventions are available for preventing these clinical problems. OBJECTIVES This study aimed to critically review the role of cryotherapy (regional hypothermia) for alleviating these adverse symptoms. METHODS A narrative review was performed, with an emphasis on randomized controlled trials. A comprehensive search using PubMed, Ovid, Embase, and MEDLINE(®) was completed. References of all cited articles also were reviewed. Data from the review were composed of articles published between 1970 and May 2013. RESULTS Available evidence suggests that regional hypothermia decreases the burden of chemotherapy-related oral mucositis, alopecia, ocular toxicity, and onycholysis. The major limitations of studies include the absence of blinded control groups and variable clinical end points. CONCLUSION Regional hypothermia decreases the burden of these four chemotherapy-induced complications and is well tolerated. More research is needed to determine what subgroups of cancer patients are most likely to respond to different types of regional hypothermia, the ideal duration of cooling needed, and further improve the ease of use of the cooling devices.
Collapse
Affiliation(s)
- Kunal C Kadakia
- Division of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Shaina A Rozell
- Division of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Anish A Butala
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | | |
Collapse
|
28
|
Breed WPM, van den Hurk CJG, Peerbooms M. Presentation, impact and prevention of chemotherapy-induced hair loss: scalp cooling potentials and limitations. ACTA ACUST UNITED AC 2014. [DOI: 10.1586/edm.10.76] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
29
|
McCarthy AL, Shaban RZ, Gillespie K, Vick J. Cryotherapy for docetaxel-induced hand and nail toxicity: randomised control trial. Support Care Cancer 2013; 22:1375-83. [PMID: 24362908 DOI: 10.1007/s00520-013-2095-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Accepted: 12/05/2013] [Indexed: 11/26/2022]
Abstract
PURPOSE This study investigated the efficacy and safety of cryotherapy, in the form of frozen gel gloves, in relation to docetaxel-induced hand and fingernail toxicities. PATIENTS AND METHODS After piloting with 21 patients, a consecutive series sample of patients (n=53) prescribed docetaxel every 3 weeks, for a minimum of three cycles, was enrolled in this randomised control trial. Participants acted as their own control, with the frozen gel glove worn on one randomised hand for 15 min prior to infusion, for the duration of the infusion, and for 15 min of after completion of treatment. Hand and nail toxicities were evaluated by two blinded assessors according to CTCAE.v4 criteria. To assess the potential for cross-infection of multi-use gloves, microbial culture and sensitivity swabs were taken of each glove at every tenth use. RESULTS Of the 53 participants enrolled in the main study, 21 provided evaluable data. There was a 60 % withdrawal rate due to patient discomfort with the intervention. The mean incidence and severity of toxicities in all evaluable cycles in control and intervention hands respectively were erythroderma grade 1 (5/5 %), nail discolouration grade 1 (81/67 %), nail loss grade 1 (19/19 %) and nail ridging grade 1 (57/57 %). No significant differences were determined between hand conditions in terms of time to event, nor in terms of toxicity in gloved and non-gloved hands. CONCLUSION While cryotherapy in the form of frozen gloves for the cutaneous toxicities associated with docetaxel is safe, its limited efficacy, patient discomfort and some logistical issues preclude its use in our clinical setting.
Collapse
|
30
|
Ekwall EM, Nygren LML, Gustafsson AO, Sorbe BG. Determination of the most effective cooling temperature for the prevention of chemotherapy-induced alopecia. Mol Clin Oncol 2013; 1:1065-1071. [PMID: 24649294 DOI: 10.3892/mco.2013.178] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Accepted: 08/06/2013] [Indexed: 01/25/2023] Open
Abstract
Computer-controlled scalp cooling to prevent alopecia is currently available for patients undergoing chemo-therapy. Previous studies have suggested that the temperature should be <22°C at a depth of 1-2 mm in the scalp to prevent alopecia. However, the optimal pre-set temperature of the coolant medium to achieve this temperature requires further investigation. A pre-study was conducted to investigate which pre-set coolant temperature of 3 and 8°C was the most effective in achieving a scalp temperature of <22°C. The temperature variations at different sites of the scalp and variations within and among the participants at baseline and during the cooling procedure were also evaluated. A randomized main study was then performed to compare the efficacy and side effects of the two temperature levels during paclitaxel/carboplatin chemotherapy. A group of 5 healthy female volunteers participated in a series of scalp temperature measurements during cooling with 3 and 8°C of the coolant medium. In the randomized main study, a total of 47 patients were included, of whom 43 were evaluable after the first cycle. A pre-set temperature of 3°C tended to be the most efficient in achieving a hair follicle temperature of <22°C. The top of the head was less responsive to scalp cooling. There were no significant differences in the prevention of alopecia between the two temperatures in the main study. However, headache and a feeling of coldness were more common in the 3°C group. A coolant temperature of 3°C was more effective in achieving a subcutaneous temperature of <22°C. However, this finding was not reflected by a significant difference in the prevention of alopecia in this study, although a higher incidence of side effects was associated with a lower temperature level.
Collapse
Affiliation(s)
- Eva M Ekwall
- Department of Oncology, Örebro University Hospital, Örebro SE-701 85; ; School of Health and Medical Sciences, Örebro University, Örebro SE-701 82
| | - Lisa M L Nygren
- Department of Oncology, Örebro University Hospital, Örebro SE-701 85
| | - Anders O Gustafsson
- Department of Biomedical Engineering, Örebro University Hospital, Örebro SE-701 85, Sweden
| | - Bengt G Sorbe
- Department of Oncology, Örebro University Hospital, Örebro SE-701 85; ; School of Health and Medical Sciences, Örebro University, Örebro SE-701 82
| |
Collapse
|
31
|
McGowan D. Chemo-induced hair loss: prevention of a distressing side-effect. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2013; 22:S12. [PMID: 23752361 DOI: 10.12968/bjon.2013.22.sup7.s12] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
|
32
|
Komen MMC, Smorenburg CH, van den Hurk CJG, Nortier JWR. Factors influencing the effectiveness of scalp cooling in the prevention of chemotherapy-induced alopecia. Oncologist 2013; 18:885-91. [PMID: 23650021 DOI: 10.1634/theoncologist.2012-0332] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The success of scalp cooling in preventing or reducing chemotherapy-induced alopecia (CIA) is highly variable between patients and chemotherapy regimens. The outcome of hair preservation is often unpredictable and depends on various factors. Methods. We performed a structured search of literature published from 1970 to February 2012 for articles that reported on factors influencing the effectiveness of scalp cooling to prevent CIA in patients with cancer. Results. The literature search identified 192 reports, of which 32 studies were considered relevant. Randomized studies on scalp cooling are scarce and there is little information on the determinants of the result. The effectiveness of scalp cooling for hair preservation depends on dose and type of chemotherapy, with less favorable results at higher doses. Temperature seems to be an important determinant. Various studies suggest that a subcutaneous scalp temperature less than 22 °C is required for hair preservation. Conclusions. The effectiveness of scalp cooling for hair preservation varies by chemotherapy type and dose, and probably by the degree and duration of cooling.
Collapse
Affiliation(s)
- Manon M C Komen
- Department of Internal Medicine and Medical Oncology, Medical Centre Alkmaar, Alkmaar, The Netherlands.
| | | | | | | |
Collapse
|
33
|
Ishiguro H, Takashima S, Yoshimura K, Yano I, Yamamoto T, Niimi M, Yamashiro H, Ueno T, Takeuchi M, Sugie T, Yanagihara K, Toi M, Fukushima M. Degree of freezing does not affect efficacy of frozen gloves for prevention of docetaxel-induced nail toxicity in breast cancer patients. Support Care Cancer 2012; 20:2017-24. [PMID: 22086405 PMCID: PMC3411307 DOI: 10.1007/s00520-011-1308-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2011] [Accepted: 10/25/2011] [Indexed: 11/29/2022]
Abstract
PURPOSE Frozen gloves (FG) are effective in preventing docetaxel-induced nail toxicity (DNT), but uncomfortable. The preventive effect of FG for DNT was compared using a standard (-25 to -30°C) or more comfortable (-10 to -20°C) preparation. METHODS Breast cancer patients receiving docetaxel were eligible. Each patient wore an FG (prepared at -10 to -20°C for 90 min) for 60 min without replacement on the right hand. The left hand was protected by standard methods (FG prepared at -25 to -30°C overnight and worn for 90 min with replacement at 45 min). The primary endpoint was DNT occurrence at 5 months. Secondary endpoints included docetaxel exposure [cumulative dose and area under the blood concentration time curve (AUC)] until DNT occurrence and discomfort from FG. The pharmacokinetics of docetaxel was assessed. RESULTS From 23 patients enrolled between December 2006 and June 2010, seven who received docetaxel for less than 5 months were excluded from evaluation. The median accumulated docetaxel dose was 700 mg/m(2) (340-1430 mg/m(2)). Within 5 months of FG use, none developed protocol-defined DNT in either hand. Two patients (13%) developed DNT at 7.2 and 7.3 months, respectively, both at -10 to -20°C. In the control hand (-25 to -30°C), discomfort occurred in 92% of the cycles, compared to 15% in the experimental hand (-10 to -20°C). Five patients (22%) experienced pain at -25 to -30°C, but none did at -10 to -20°C. The degree of docetaxel exposure was not related to DNT occurrence in our study. CONCLUSION A convenient preparation of FG at -10 to -20°C is almost as effective as a standard preparation at -25 to -30°C, with significantly less discomfort.
Collapse
Affiliation(s)
- H Ishiguro
- Outpatient Oncology Unit, Kyoto University Hospital, Kyoto, Japan.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
34
|
Chon SY, Champion RW, Geddes ER, Rashid RM. Chemotherapy-induced alopecia. J Am Acad Dermatol 2012; 67:e37-47. [DOI: 10.1016/j.jaad.2011.02.026] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2010] [Revised: 02/05/2011] [Accepted: 02/13/2011] [Indexed: 11/15/2022]
|
35
|
Wikramanayake TC, Villasante AC, Mauro LM, Nouri K, Schachner LA, Perez CI, Jimenez JJ. Low-level laser treatment accelerated hair regrowth in a rat model of chemotherapy-induced alopecia (CIA). Lasers Med Sci 2012; 28:701-6. [DOI: 10.1007/s10103-012-1139-7] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2011] [Accepted: 06/04/2012] [Indexed: 11/30/2022]
|
36
|
Short post-infusion scalp cooling time in the prevention of docetaxel-induced alopecia. Support Care Cancer 2012; 20:3255-60. [PMID: 22539051 DOI: 10.1007/s00520-012-1465-0] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2011] [Accepted: 04/02/2012] [Indexed: 10/28/2022]
Abstract
PURPOSE The patient impact of chemotherapy-induced alopecia (CIA) is high. Scalp cooling is applied to reduce CIA. The potential optimum post-infusion cooling times (PICTs) are currently unknown. METHODS Scalp cooling was applied in 53 patients receiving docetaxel chemotherapy with 90-min PICT (observational part). Also 15 non-scalp-cooled patients were included. If hair preservation was observed in >80 % of the patients, randomisation between 45 and 90-min PICT was planned. Patients reported tolerance of scalp cooling and use of head covering. RESULTS Observational study: 81 % of scalp-cooled patients did not require head covering versus 27 % of non-scalp-cooled patients. Randomised study: 79 % of 38 patients with 90-min PICT did not need head covering versus 95 % of 38 patients with 45-min PICT (p = 0.04). Scalp cooling was very well tolerated (visual analogue scale = 79). CONCLUSION A 45-min PICT can be recommended in 3-weekly docetaxel regimens with a dose of 75 or 100 mg/m(2), administered in 60 min. The shorter PICT is a major advantage in time investment for patients. Patients (women and men) who receive docetaxel, except combined with doxorubicin and cyclophosphamide (taxotere, adriamycin and cyclophosphamide (TAC)) should be informed about the protective effect and high tolerability of scalp cooling in avoiding CIA.
Collapse
|
37
|
Effects of alopecia on body image and quality of life of Turkish cancer women with or without headscarf. Support Care Cancer 2011; 20:2349-56. [DOI: 10.1007/s00520-011-1338-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2011] [Accepted: 11/29/2011] [Indexed: 10/14/2022]
|
38
|
|
39
|
Abstract
This article provides insight into the growth cycle of a hair follicle and the potential impact chemotherapy agents can have on this process, which often results in hair loss (alopecia). It explores the psychological consequences of chemotherapy-induced alopecia for an individual as a result of the perceptions of others as well as an individual's perception of his or her self-image. Despite the development of various forms of scalp cooling, chemotherapy-induced alopecia remains a major side effect for patients receiving chemotherapy; however, there have been improvements in wig provision and changing public opinion relating to baldness. Although chemotherapy-induced alopecia affects both males and females and all age groups, this article focuses on the potential impact for patients receiving chemotherapy as a form of treatment for breast cancer. As professionals we need to understand the social significance of hair in relation to a person's outward presentation and social interactions, along with the possible psychological implications of a person losing his or her bodily hair, and not just the head hair. We must aim to minimize the distress alopecia can cause by: ensuring we provide patients with up-to-date verbal and written information to enable them to prepare for losing their hair; helping them to preserve their self-image and minimize the psychological consequences of hair loss while receiving chemotherapy; and preparing them for their hair re-growth following completion of chemotherapy.
Collapse
Affiliation(s)
- Helen Roe
- North Cumbria University Hospitals, NHS Trust
| |
Collapse
|
40
|
Kargar M, Sarvestani RS, Khojasteh HN, Heidari MT. Efficacy of penguin cap as scalp cooling system for prevention of alopecia in patients undergoing chemotherapy. J Adv Nurs 2011; 67:2473-7. [PMID: 21635283 DOI: 10.1111/j.1365-2648.2011.05668.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIMS The present study examines the efficacy of a scalp cooling system to prevent chemotherapy-induced alopecia in people with cancer. BACKGROUND Alopecia has been established as the most distressing aspect of chemotherapy to such an extent that some patients even refrain from cytotoxic treatment. METHODS Using a quasi-experimental approach in 2007, a total number of 63 patients aged 16-59 years (mean 35 ± 5·5 years) participated in the study and were treated with an intravenous regimen of chemotherapy drug. Thirty-one patients accepting the scalp-cooling system were compared for alopecia with 32 participants who refused it. Hair loss in the participants was evaluated by nurses using World Health Organization criteria at each cycle of chemotherapy. RESULTS Using chi-square test differences between the two groups were statistically significant at cycles 2-6 (P < 0·05). Twenty-four participants (77·4%) of the study group were assessed as first and second grade of alopecia in the second cycle, whereas seven participants (22·6%) of this group exhibited third and fourth grade of alopecia. However, in the control group at the same cycle, 19 participants (61·3%) were assessed with third and fourth grade of alopecia. In the Sixth cycle 15 participants (50%) of the study group and 24 participants (75%) of the control group demonstrated third and fourth grade alopecia. CONCLUSION A penguin cap can be an effective method to avoid alopecia in patients receiving chemotherapy drugs. However, it is important to bear in mind that because of individual characteristics, liver function and drug regimens it is not successful in all cases.
Collapse
Affiliation(s)
- Marzieh Kargar
- Department of Nursing, Shiraz University of Medical Sciences, Iran.
| | | | | | | |
Collapse
|
41
|
Abstract
REASONS FOR PERFORMING STUDY The hypometabolic and vasoconstrictive effects of cryotherapy could prevent the development of laminitis. OBJECTIVES To use distal limb cryotherapy to prevent laminitis induced by alimentary carbohydrate overload. METHODS Laminitis was induced in 6 Standardbred horses that had one front limb continuously cooled in an ice/water mixture. Lameness evaluation, blinded lamellar histological grading and analysis for lamellar matrix metalloproteinase-2 (MMP-2) mRNA expression were used to evaluate the severity of laminitis. RESULTS Cryotherapy was well tolerated and effective in cooling the feet. In each horse no lameness was observed in the treated limbs. Laminitis histology scores in the treated limbs were significantly less than those of the corresponding untreated forelimbs (P < 0.05). Laminitis histology scores in the treated limbs were also significantly less than those of the untreated limbs (fore- and hind) as a group (P < 0.05). Expression of MMP-2 mRNA in the iced feet was significantly (P < 0.05) less than that detected in the untreated feet. CONCLUSIONS Cryotherapy, when applied to one foot, markedly reduced the severity of acute laminitis in this study. We propose that vasoconstriction (preventing delivery of haematogenous trigger factors) and hypometabolism (reduction in lamellar MMP activity) were the primary therapeutic mechanisms. POTENTIAL RELEVANCE Although further research is needed, we suggest cryotherapy as a potentially effective prophylactic strategy in horses at risk of developing acute laminitis.
Collapse
Affiliation(s)
- A W van Eps
- Australian Equine Laminitis Research Unit, School of Veterinary Science, Faculty of Natural Resources Agriculture and Veterinary Science, The University of Queensland, St. Lucia, Queensland 4072, Australia
| | | |
Collapse
|
42
|
Mols F, van den Hurk CJ, Vingerhoets AJJM, Breed WPM. Scalp cooling to prevent chemotherapy-induced hair loss: practical and clinical considerations. Support Care Cancer 2008; 17:181-9. [PMID: 18560904 DOI: 10.1007/s00520-008-0475-4] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2008] [Accepted: 05/22/2008] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The objective of this prospective multicenter study was to obtain insight into the severity and burden of hair loss among cancer patients treated with chemotherapy. In addition, we described the effectiveness and burden of scalp cooling and the satisfaction with wigs, with hair regrowth, and with body image. MATERIALS AND METHODS Breast cancer patients treated with (n = 98) and without (n = 168) scalp cooling completed questionnaires before chemotherapy and 3 weeks and 6 months after completion of chemotherapy. RESULTS Scalp cooling was effective in preventing chemotherapy-induced hair loss in 32 of 62 available patients (52%). Even though patients knew hair loss was temporary, it was a burden to 54% of them (n = 100). Scalp cooling was a burden for only 17 out of 51 patients (33%). Most patients who used a wig or head cover were satisfied with it (82%, n = 126). Patients were moderately satisfied with the regrowth of their hair after chemotherapy (mean 11.6; SD 2.53; range 0-20). Successfully cooled patients rated their hair as less important for their body image compared to patients who did experience hair loss (p = 0.014). DISCUSSION Chemotherapy-induced hair loss is perceived as burdensome. It may be prevented by offering scalp cooling which is often an effective method to prevent this form of hair loss and is tolerated well by patients. However, if possible, scalp-cooling techniques should be improved and their effectiveness should be increased because if scalp cooling is unsuccessful, patients' rate their hair loss as more burdensome compared to noncooled patients.
Collapse
Affiliation(s)
- Floortje Mols
- CoRPS-Center of Research on Psychology in Somatic Diseases, Tilburg University, Tilburg, the Netherlands.
| | | | | | | |
Collapse
|
43
|
Scotté F, Banu E, Medioni J, Levy E, Ebenezer C, Marsan S, Banu A, Tourani JM, Andrieu JM, Oudard S. Matched case-control phase 2 study to evaluate the use of a frozen sock to prevent docetaxel-induced onycholysis and cutaneous toxicity of the foot. Cancer 2008; 112:1625-31. [PMID: 18286527 DOI: 10.1002/cncr.23333] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Onycholysis occurs in approximately 30% of patients treated with docetaxel. The efficacy and safety of an Elasto-Gel frozen sock (FS) was investigated for the prevention of docetaxel-induced nail and skin toxicity of the feet. METHODS Patients receiving docetaxel at a dose of 70 to 100 mg/m(2) every 3 weeks were eligible for this matched case-control study. Each patient wore an FS for 90 minutes on the right foot. The unprotected left foot acted as control. Nail and skin toxicities were assessed using National Cancer Institute Common Toxicity Criteria (version 3) and compared using a 2-sample Wilcoxon matched-pairs rank test adjusted for tied values. RESULTS Fifty consecutive patients were included between April 2005 and January 2007. Nail toxicity was significantly lower in the FS-protected foot compared with the control foot (grade 0: 100% versus 79%; and grade 1 and 2: 0% versus 21%, respectively) (P= .002). Skin toxicity was grade 0: 98% versus 94%; and grade 1 and 2: 2% versus 6% in the FS-protected and the control feet, respectively. The median times until toxicity occurrence were not found to differ significantly between the groups. One patient experienced discomfort because of cold intolerance. CONCLUSIONS Cold therapy using FS significantly reduced the incidence of docetaxel-induced foot nail toxicity, as previously demonstrated using frozen gloves for the hands.
Collapse
Affiliation(s)
- Florian Scotté
- Department of Medical Oncology, Georges Pompidou European Hospital, Paris, France. florian,
| | | | | | | | | | | | | | | | | | | |
Collapse
|
44
|
Mulders M, Vingerhoets A, Breed W. The impact of cancer and chemotherapy: Perceptual similarities and differences between cancer patients, nurses and physicians. Eur J Oncol Nurs 2008; 12:97-102. [DOI: 10.1016/j.ejon.2007.10.002] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2007] [Revised: 09/25/2007] [Accepted: 10/03/2007] [Indexed: 10/22/2022]
|
45
|
Jimenez JJ, Roberts SM, Mejia J, Mauro LM, Munson JW, Elgart GW, Connelly EA, Chen Q, Zou J, Goldenberg C, Voellmy R. Prevention of chemotherapy-induced alopecia in rodent models. Cell Stress Chaperones 2008; 13:31-8. [PMID: 18347939 PMCID: PMC2666212 DOI: 10.1007/s12192-007-0005-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2007] [Revised: 07/18/2007] [Accepted: 07/19/2007] [Indexed: 11/30/2022] Open
Abstract
Alopecia (hair loss) is experienced by thousands of cancer patients every year. Substantial-to-severe alopecia is induced by anthracyclines (e.g., adriamycin), taxanes (e.g., taxol), alkylating compounds (e.g., cyclophosphamide), and the topisomerase inhibitor etoposide, agents that are widely used in the treatment of leukemias and breast, lung, ovarian, and bladder cancers. Currently, no treatment appears to be generally effective in reliably preventing this secondary effect of chemotherapy. We observed in experiments using different rodent models that localized administration of heat or subcutaneous/intradermal injection of geldanamycin or 17-(allylamino)-17-demethoxygeldanamycin induced a stress protein response in hair follicles and effectively prevented alopecia from adriamycin, cyclophosphamide, taxol, and etoposide. Model tumor therapy experiments support the presumption that such localized hair-saving treatment does not negatively affect chemotherapy efficacy.
Collapse
Affiliation(s)
| | - Stephen M. Roberts
- Center for Environmental and Human Toxicology, Department of Physiological Sciences, University of Florida, Gainesville, FL USA
| | - Jessica Mejia
- Department of Biochemistry and Molecular Biology, University of Miami, Miami, FL USA
| | - Lucia M. Mauro
- Department of Biochemistry and Molecular Biology, University of Miami, Miami, FL USA
| | - John W. Munson
- Center for Environmental and Human Toxicology, Department of Physiological Sciences, University of Florida, Gainesville, FL USA
| | - George W. Elgart
- Department of Dermatology and Cutaneous Surgery, University of Miami, Miami, FL USA
| | - Elizabeth Alvarez Connelly
- Department of Dermatology and Cutaneous Surgery, University of Miami, Miami, FL USA
- Department of Pediatrics, University of Miami, Miami, FL USA
| | - Qingbin Chen
- School of Pharmaceutical Science, Zhongshan Medical College, Sun Yat-sen University, Guangzhou, People’s Republic of China
| | - Jiangying Zou
- Guangzhou Institute of Biomedicine and Health, Guangzhou, People’s Republic of China
| | | | - Richard Voellmy
- Department of Biochemistry and Molecular Biology, University of Miami, Miami, FL USA
- HSF Pharmaceuticals S.A., Av. des Cerisiers 39B, 1009 Pully, Switzerland
| |
Collapse
|
46
|
Effects of temperature and doxorubicin exposure on keratinocyte damage in vitro. In Vitro Cell Dev Biol Anim 2008; 44:81-6. [PMID: 18193326 PMCID: PMC2277440 DOI: 10.1007/s11626-007-9074-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2007] [Accepted: 11/20/2007] [Indexed: 11/29/2022]
Abstract
Cancer chemotherapy treatment often leads to hair loss, which may be prevented by cooling the scalp during drug administration. The current hypothesis for the hair preservative effect of scalp cooling is that cooling of the scalp skin reduces blood flow (perfusion) and chemical reaction rates. Reduced perfusion leads to less drugs available for uptake, whereas the reduced temperature decreases uptake of and damage by chemotherapy. Altogether, less damage is exerted to the hair cells, and the hair is preserved. However, the two mechanisms in the hypothesis have not been quantified yet. To quantify the effect of reduced drug damage caused by falling temperatures, we investigated the effect of local drug concentration and local tissue temperature on hair cell damage using in vitro experiments on keratinocytes. Cells were exposed for 4 h to a wide range of doxorubicin concentrations. During exposure, cells were kept at different temperatures. Cell viability was determined after 3 d using a viability test. Control samples were used to establish a concentration–viability curve. Results show that cell survival is significantly higher in cooled cells (T < 22° C) than in non-cooled cells (T = 37° C), but no significant differences are visible between T = 10° C and T = 22° C. Based on this result and previous work, we can conclude that there is an optimal temperature in scalp cooling. Further cooling will only result in unnecessary discomfort for the patient and should therefore be avoided.
Collapse
|
47
|
|
48
|
Dougherty L. Using Nursing Diagnoses in Prevention and Management of Chemotherapy-Induced Alopecia in the Cancer Patient. ACTA ACUST UNITED AC 2007; 18:142-9. [DOI: 10.1111/j.1744-618x.2007.00069.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
49
|
Lümmen G, Jäger T, Sommer F, Ebert T, Schmitz-Draeger B. [Nutrition, lifestyle, physical activity, and supportive care during chemotherapeutic treatment]. Urologe A 2007; 45:555-8, 560-5. [PMID: 16607518 DOI: 10.1007/s00120-006-1037-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
With improvements in cancer survival rates, more patients with cancer are living longer and the influence of nutrition, lifestyle, physical activity as well as supportive care during and after chemotherapy is of increasing interest. In several malignancies smoking cessation increases cancer survival. Similar effects are expected by healthy nutrition. Regular physical activity of cancer patients reduces drug interactions of chemotherapy, decreases the number of comorbid conditions, and helps patients maintain independence as long as possible. For supportive care during chemotherapy the 5-HT3 receptor antagonists are more effective for the prevention of chemotherapy-induced nausea and vomiting. There are several colony-stimulating factors (e.g. GCSF, erythropoietin) for hematopoietic recovery post-chemotherapy. Altogether supportive care of chemotherapy reduces toxicity and increases efficacy.
Collapse
Affiliation(s)
- G Lümmen
- Klinik für Urologie und Kinderurologie, St.-Agnes-Hospital, Barloer Weg 125, 46397, Bocholt.
| | | | | | | | | |
Collapse
|
50
|
Wang J, Lu Z, Au JLS. Protection Against Chemotherapy-Induced Alopecia. Pharm Res 2006; 23:2505-14. [PMID: 16972183 DOI: 10.1007/s11095-006-9105-3] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2006] [Accepted: 06/28/2006] [Indexed: 10/24/2022]
Abstract
PURPOSE The goal is to provide an overview on the advances in protection against chemotherapy-induced alopecia (CIA). MATERIALS AND METHODS The four major parts of this review are (a) overview of the hair follicle biology, (b) characteristics of CIA, (c) state-of-the-art animal models of CIA, and (d) experimental approaches on protection against CIA. RESULTS The hair follicle represents an unintended target of cancer chemotherapy. CIA is a significant side effect that compromises the quality of life of patients. Overcoming CIA represents an area of unmet needs, especially for females and children. Significant progresses have been made in the last decade on the pathobiology of CIA. The pharmacological agents under evaluation include drug-specific antibodies, hair growth cycle modifiers, cytokines and growth factors, antioxidants, cell cycle or proliferation modifiers, and inhibitors of apoptosis. Their potential applications and limitations are discussed. CONCLUSION Multiple classes of agents with different action mechanisms have been evaluated in animal CIA models. Most of these protective agents have activity limited to a single chemotherapeutic agent. In comparison, calcitriol and cyclosporine A have broader spectrum of activity and can prevent against CIA by multiple chemotherapeutic agents. Among the three agents that have been evaluated in humans, AS101 and Minoxidil were able to reduce the severity or shorten the duration of CIA but could not prevent CIA.
Collapse
Affiliation(s)
- Jie Wang
- College of Pharmacy, The Ohio State University, Columbus, Ohio, USA
| | | | | |
Collapse
|