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Cheret J, Samra T, Verling SD, Gherardini J, Rodriguez-Feliz J, Bauman AJ, Sanchez CA, Wikramanayake TC, Xu XX, Paus R. Low-Intensity Ultrasound as a Potential Intervention Strategy to Protect Human Scalp Hair Follicles from Taxane-Induced Toxicity. J Invest Dermatol 2023; 143:1809-1813.e2. [PMID: 36990174 DOI: 10.1016/j.jid.2023.02.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 02/09/2023] [Accepted: 02/22/2023] [Indexed: 03/30/2023]
Affiliation(s)
- Jeremy Cheret
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, Miller School of Medicine, University of Miami, Florida, USA
| | - Tara Samra
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, Miller School of Medicine, University of Miami, Florida, USA
| | - Samantha D Verling
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, Miller School of Medicine, University of Miami, Florida, USA
| | - Jennifer Gherardini
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, Miller School of Medicine, University of Miami, Florida, USA
| | | | - Alan J Bauman
- Bauman Medical Hair Transplant & Hair Loss Treatment Center, Boca Raton, Florida, USA
| | - Celina Amaya Sanchez
- Department of Radiation Oncology, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Tongyu C Wikramanayake
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, Miller School of Medicine, University of Miami, Florida, USA
| | - Xiang-Xi Xu
- Department of Radiation Oncology, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Ralf Paus
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, Miller School of Medicine, University of Miami, Florida, USA; Monasterium Laboratory, Münster, Germany; CUTANEON, Hamburg, Germany.
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Delgado Rodríguez J, Ramos-García V, Infante-Ventura D, Suarez-Herrera JC, Rueda-Domínguez A, Serrano-Aguilar P, Del Mar Trujillo-Martín M. Ethical, legal, organizational and social issues related to the use of scalp cooling for the prevention of chemotherapy-induced alopecia: A systematic review. Health Expect 2023; 26:567-578. [PMID: 36585793 PMCID: PMC10010082 DOI: 10.1111/hex.13679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 11/15/2022] [Accepted: 11/16/2022] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION Scalp cooling (SC) aims to prevent chemotherapy-induced alopecia. The goal of this systematic review is to tackle ethical, legal, organizational and social issues related to SC. METHODS A critical appraisal of the literature was carried out using a systematic review design. MEDLINE, Embase and Web of Science databases were searched up until 2 June 2021. Studies addressing these aspects in English or Spanish were considered. Representatives of both patient associations and professional scientific societies related to the topic participated in the design of the protocol and the review of the findings. RESULTS A total of 17 studies were included. Articles were critically appraised using the MMAT and SANRA. Findings were organized into four categories: (1) ethical aspects focused on equal access, gender equity and doctor-patient communication supported by Patient Decision Aids (PtDAs); (2) patient perspective and acceptability; (3) professional perspective and acceptability; (4) organizational aspects focused on accessibility and feasibility. CONCLUSION Cancer patients' expectations when using SC need to be adjusted to reduce the potential distress associated with hair loss. PtDAs could help patients clarify their values and preferences regarding SC. Equal access to technology should be guaranteed. PATIENT OR PUBLIC CONTRIBUTION In this systematic review, the representatives of the patient associations (Ms. María Luz Amador Muñoz of the Spanish Association Against Cancer [AECC] and Ms. Catiana Martinez Cánovas of the Spanish Breast Cancer Federation [FECMA]) participated in the review of the study protocol, as well as in the results, discussion and conclusions, making their contributions. In the type of design of these studies (systematic reviews), it is not usual to have the direct participation of patients, but in this one, we have done so, as it is a systematic review that is part of a report of the Spanish Network of Health Technology Assessment Agencies (ETS).
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Affiliation(s)
- Janet Delgado Rodríguez
- Department of Philosophy, University of Granada, Granada, Spain.,The Spanish Network of Agencies for Health Technology Assessment and Services of the National Health System (RedETS), Tenerife, Spain
| | - Vanesa Ramos-García
- The Spanish Network of Agencies for Health Technology Assessment and Services of the National Health System (RedETS), Tenerife, Spain.,Canary Islands Health Research Institute Foundation (FIISC), Tenerife, Spain.,Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Tenerife, Spain
| | - Diego Infante-Ventura
- The Spanish Network of Agencies for Health Technology Assessment and Services of the National Health System (RedETS), Tenerife, Spain.,Canary Islands Health Research Institute Foundation (FIISC), Tenerife, Spain
| | - José Carlos Suarez-Herrera
- The Spanish Network of Agencies for Health Technology Assessment and Services of the National Health System (RedETS), Tenerife, Spain.,Department of Strategy, Entrepreneurship and Sustainable Development KEDGE Business School, Marseille, France.,Cátedra UNITWIN/UNESCO de IPD-SILOS Universidad de Las Palmas de Gran Canaria, Las Palmas, Spain
| | - Antonio Rueda-Domínguez
- Medical Oncology Intercenter Unit, Regional and Virgen de la Victoria University Hospitals, IBIMA, Málaga, Spain.,Research Network on Health Services in Chronic Diseases (REDISSEC), Málaga, Spain
| | - Pedro Serrano-Aguilar
- The Spanish Network of Agencies for Health Technology Assessment and Services of the National Health System (RedETS), Tenerife, Spain.,Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Tenerife, Spain.,Evaluation Unit of the Canary Islands Health Service (SESCS), Tenerife, Spain.,Research Network on Health Services in Chronic Diseases (REDISSEC), Tenerife, Spain
| | - María Del Mar Trujillo-Martín
- The Spanish Network of Agencies for Health Technology Assessment and Services of the National Health System (RedETS), Tenerife, Spain.,Canary Islands Health Research Institute Foundation (FIISC), Tenerife, Spain.,Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Tenerife, Spain.,Research Network on Health Services in Chronic Diseases (REDISSEC), Tenerife, Spain
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3
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Integrative and Mechanistic Approach to the Hair Growth Cycle and Hair Loss. J Clin Med 2023; 12:jcm12030893. [PMID: 36769541 PMCID: PMC9917549 DOI: 10.3390/jcm12030893] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Revised: 01/16/2023] [Accepted: 01/20/2023] [Indexed: 01/24/2023] Open
Abstract
The hair cycle is composed of four primary phases: anagen, catagen, telogen, and exogen. Anagen is a highly mitotic phase characterized by the production of a hair shaft from the hair follicle, whereas catagen and telogen describe regression and the resting phase of the follicle, respectively, ultimately resulting in hair shedding. While 9% of hair follicles reside in telogen at any time, a variety of factors promote anagen to telogen transition, including inflammation, hormones, stress, nutritional deficiency, poor sleep quality, and cellular division inhibiting medication. Conversely, increased blood flow, direct stimulation of the hair follicle, and growth factors promote telogen to anagen transition and subsequent hair growth. This review seeks to comprehensively describe the hair cycle, anagen and telogen balance, factors that promote anagen to telogen transition and vice versa, and the clinical utility of a variety of lab testing and evaluations. Ultimately, a variety of factors impact the hair cycle, necessitating a holistic approach to hair loss.
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Petruzzi A, Mancuso AM, Alfieri S, Esposito A, Infante G, Miceli R, Ospitali S, Ripamonti CI, Borreani C. Evaluation of the CNC ® prosthetic system in recurrent breast cancer patients with chemotherapy-induced alopecia: a pilot study. BMC Womens Health 2022; 22:492. [PMID: 36463143 PMCID: PMC9719124 DOI: 10.1186/s12905-022-02080-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 11/14/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Chemotherapy-induced alopecia (CIA), although generally reversible, is felt as extremely distressing by patients with breast cancer. A certified medical device (Capelli Naturali a Contatto®-CNC®) was produced to provide patients with a personalized scalp prosthesis, reproducing the patient's original hair, resistant to any type of everyday or sporting activity, and hairdressing. AIMS The present study aimed to evaluate the impact of the CNC® device on the patient's perception of their body image, psychological wellbeing, satisfaction, strengths and weakness of the CNC® device. METHOD A pilot study was carried out on 21 patients affected by CIA due to recurrent breast cancer. A mixed quantitative/qualitative method was used, including administering a questionnaire and a focus group. RESULTS Based on the Body Image Scale, body image perception improved after 3 and 6 months using the device in the 20 patients who answered the questionnaire. No significant change over time emerged for the six dimensions investigated by the Italian version of the Psychological Well-Being Scale. The thematic analysis of the focus groups showed six themes: definition of the prosthetic device, acceptance of the proposal, experience with the conventional wig, strengths, weaknesses, economic issues. CONCLUSION Compared to the previous experience of CIA and the standard wig, the use of the CNC® device improved everyday life and may be proposed to women undergoing chemotherapy and expecting alopecia to prevent discomfort, social embarrassment, and compromised body image.
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Affiliation(s)
| | | | - Sara Alfieri
- grid.417893.00000 0001 0807 2568Clinical Psychology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Giacomo Venezian 1, 20133 Milan, Italy
| | | | - Gabriele Infante
- grid.4708.b0000 0004 1757 2822Laboratory of Medical Statistics, Biometry and Epidemiology “G. A. Maccacaro”, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy ,grid.417893.00000 0001 0807 2568S.S. Biostatistics for Clinical Research, Department Epidemiology and Data Science Department of Applied Research and Technological Development, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Rosalba Miceli
- grid.417893.00000 0001 0807 2568S.S. Biostatistics for Clinical Research, Department Epidemiology and Data Science Department of Applied Research and Technological Development, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Carla Ida Ripamonti
- grid.417893.00000 0001 0807 2568Supportive Care in Cancer Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Claudia Borreani
- grid.417893.00000 0001 0807 2568Clinical Psychology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Giacomo Venezian 1, 20133 Milan, Italy
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Saadet ED, Tek I. Evaluation of chemotherapy-induced cutaneous side effects in cancer patients. Int J Dermatol 2022; 61:1519-1526. [PMID: 35867950 DOI: 10.1111/ijd.16361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 06/03/2022] [Accepted: 06/29/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Cutaneous side effects are commonly seen in cancer chemotherapy. As new chemotherapy drugs are developed, the frequency and the diversity of these cutaneous side effects increase. For this reason, identification and management of these side effects are an important part of the treatment of cancer patients. This study aimed to investigate mucocutaneous side effects of conventional chemotherapy and targeted therapy agents that are used in cancer patients. METHODS In this cross-sectional study, 231 cancer patients, who received single or combination chemotherapy at the oncology department of our hospital between 2013 and 2020, were retrospectively reviewed, and mucocutaneous side effects we evaluated. RESULTS The ages of the patients varied between 27 and 90 years with a median age of 60 years. Of the patients, 136 (58.9%) were women, and 95 (41.1%) were men. Combination chemotherapy was applied to 174 patients (71.9%). Mucocutaneous side effects were present in 558 patients. The most common side effect was alopecia, which was observed in 158 patients (65.6%). This was followed by mucositis (39.4%), hand-foot syndrome (35.3%), papulopustular rash (22%), dermatitis (18.3%), xerosis (14.1%), nail disorders (12%), and others. CONCLUSIONS Although chemotherapy-induced cutaneous side effects are not usually life-threatening, they may lead to the development of morbidity and discontinuance or termination of the treatment. Therefore, these side effects should be well managed to improve the quality of life of cancer patients.
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Affiliation(s)
- Elif Demirci Saadet
- Department of Dermatology, Medicana International Ankara Hospital, Ankara, Turkey
| | - Ibrahim Tek
- Department of Medical Oncology, Medicana International Ankara Hospital, Ankara, Turkey
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Low temperature mitigating the paclitaxel-induced damages in mouse cell and hair follicle model. Biochem Biophys Res Commun 2022; 603:94-101. [DOI: 10.1016/j.bbrc.2022.03.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 03/01/2022] [Accepted: 03/06/2022] [Indexed: 11/19/2022]
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Versluis A, van Alphen K, Dercksen W, de Haas H, van den Hurk C, Kaptein AA. "Dear hair loss"-illness perceptions of female patients with chemotherapy-induced alopecia. Support Care Cancer 2022; 30:3955-3963. [PMID: 35048177 DOI: 10.1007/s00520-021-06748-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 12/07/2021] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Chemotherapy-induced alopecia (CIA) is one of the most common and distressing side effects of chemotherapy treatment. This study aims to assess the illness perceptions of female patients dealing with CIA, and their associations with demographic and clinical characteristics, coping strategies, and quality of life. The secondary aim was to compare the illness perceptions of patients with CIA with other samples, to help elucidate the specific perceptions of patients with CIA. METHOD Forty female patients at risk of severe hair loss due to chemotherapy treatment were included at the oncological daycare unit of a teaching hospital in the Netherlands. Patients were asked to complete the Brief-Illness Perception Questionnaire (B-IPQ) and the Hair Quality of Life (Hair-QoL) questionnaire. RESULTS Illness perceptions indicated that although patients understood their hair loss, they lacked being able to make sense of managing it, negatively impacting patients' lives. Psychological quality of life was significantly correlated with the B-IPQ domains: consequences, degree of concern, and emotional response. Social quality of life was significantly correlated with psychological quality of life. Patients with CIA felt significantly less able to manage their hair loss, compared to patients with breast cancer and psoriatic arthritis. CONCLUSION As patients' beliefs of being able to manage their hair loss are important for adopting and maintaining adequate coping behaviors, additional effort of health care providers in fostering patients' sense of control is indicated, focusing on patients' strengths during and after chemotherapy treatment. In the context of developing interventions for patients with CIA, consequences, concern, and emotional response are the major dimensions that should be taken in account to help patients deal with hair loss.
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Affiliation(s)
- Anne Versluis
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Godebaldkwartier 419, 3511 DT, Utrecht, The Netherlands.
| | - Kirsten van Alphen
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Godebaldkwartier 419, 3511 DT, Utrecht, The Netherlands
| | - Wouter Dercksen
- Department of Medical Oncology, Máxima Medical Centre, Eindhoven, The Netherlands
| | - Henk de Haas
- Department of Medical Oncology, Máxima Medical Centre, Eindhoven, The Netherlands
| | - Corina van den Hurk
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Godebaldkwartier 419, 3511 DT, Utrecht, The Netherlands
| | - Ad A Kaptein
- Department of Medical Psychology, Leiden University Medical Centre, Leiden, The Netherlands
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Chemotherapeutic and Safety Profile of a Fraction from Mimosa caesalpiniifolia Stem Bark. JOURNAL OF ONCOLOGY 2021; 2021:9031975. [PMID: 34917149 PMCID: PMC8670915 DOI: 10.1155/2021/9031975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 10/22/2021] [Accepted: 11/17/2021] [Indexed: 11/17/2022]
Abstract
Mimosa caesalpiniifolia (Fabaceae) is used by Brazilian people to treat hypertension, bronchitis, and skin infections. Herein, we evaluated the antiproliferative action of the dichloromethane fraction from M. caesalpiniifolia (DFMC) stem bark on murine tumor cells and the in vivo toxicogenetic profile. Initially, the cytotoxic activity of DFMC on primary cultures of Sarcoma 180 (S180) cells by Alamar Blue, trypan, and cytokinesis block micronucleus (CBMN) assays was assessed after 72 h of exposure, followed by the treatment of S180-bearing Swiss mice for 7 days, physiological investigations, and DNA/chromosomal damage. DFMC and betulinic acid revealed similar in vitro antiproliferative action on S180 cells and induced a reduction in viable cells, induced a reduction in viable cells and caused the emergence of bridges, buds, and morphological features of apoptosis and necrosis. S180-transplanted mice treated with DFMC (50 and 100 mg/kg/day), a betulinic acid-rich dichloromethane, showed for the first time in vivo tumor growth reduction (64.8 and 80.0%) and poorer peri- and intratumor quantities of vessels. Such antiproliferative action was associated with detectible side effects (loss of weight, reduction of spleen, lymphocytopenia, and neutrophilia and increasing of GOT and micronucleus in bone marrow), but preclinical general anticancer properties of the DFMC were not threatened by toxicological effects, and these biomedical discoveries validate the ethnopharmacological reputation of Mimosa species as emerging phytotherapy sources of lead molecules.
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Santos TS, Hernandéz Galvis K, Vañó Galván S, Saceda-Corralo D. Post-chemotherapy alopecia: what the dermatologist needs to know. Int J Dermatol 2021; 60:1313-1317. [PMID: 34348414 DOI: 10.1111/ijd.15812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 06/19/2021] [Accepted: 07/02/2021] [Indexed: 11/29/2022]
Abstract
It is estimated that chemotherapy-induced alopecia (CIA) occurs in 65% of chemotherapeutic patients. Forty-seven percent of cancer patients consider hair loss to be the most traumatic aspect of therapy. CIA can be anticipated, depending on the regimen used, and doctors should be aware of the treatments that can minimize it. Careful evaluation before chemotherapy treatment should be performed, and trichoscopy may be useful. Dermatologists do not generally evaluate postchemotherapy alopecia. However, there is an increasing number of reports of permanent chemotherapy-induced alopecia, and these patients require treatment.
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Lacouture ME, Dion H, Ravipaty S, Jimenez JJ, Thapa K, Grund EM, Benaim E, Tanna N, Luan S, DiTommaso N, Narain NR, Sarangarajan R, Granger E, Berman B, Goldfarb SB. A phase I safety study of topical calcitriol (BPM31543) for the prevention of chemotherapy-induced alopecia. Breast Cancer Res Treat 2020; 186:107-114. [PMID: 33206291 DOI: 10.1007/s10549-020-06005-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 10/27/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE Chemotherapy-induced alopecia (CIA) negatively affects psychosocial health and quality of life (QoL). Currently, there are no approved pharmacologic agents to prevent CIA. Here, we evaluated the safety, tolerability, and potential signal of efficacy of topical calcitriol (BPM31543) on CIA prevention. MATERIALS AND METHODS This Phase 1 trial included 23 female patients with breast cancer, gynecologic cancer, or sarcomas receiving a taxane-based chemotherapy. Patients received a 3 + 3 dose-escalation regimen at 5, 10, 20, 40, 60, and 80 μg/mL, with 3-6 patients per group. Patients applied topical BPM31543 to the scalp twice a day for 2 weeks prior to chemotherapy and continued until chemotherapy treatment was completed. The maximum tolerated dose (MTD) during first 28 day application was determined. Adverse event (AE) monitoring, pharmacokinetics, blinded photographic assessments, and patient self-assessment were evaluated. RESULTS Out of 23 patients treated with BPM31543, 8 patients experienced at least 1 treatment-related adverse event (AE). The majority of AEs were mild to moderate in severity. Only 1 patient experienced SAEs (vomiting, nausea, fever, and flank pain) considered treatment related. Alopecia < 50% from baseline was observed in 8 patients at Week 7, and, of which 2 patients had < 50% alopecia maintained at Week 15. There were no detectable effects of topical BPM31543 on serum levels of calcitriol. CONCLUSIONS BPM31543 applied topically twice daily to the scalp is safe and well tolerated in patients receiving taxane-based chemotherapy. No DLT was observed at up to 80 µg/mL, and MTD was not reached. Based on the data from this trial, BPM31543 represents a promising therapy and warrants further investigation in Phase 2/3 trials.
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Affiliation(s)
- Mario E Lacouture
- Department of Medicine, Memorial Sloan Kettering Cancer Center, 530 East 74th Street, New York, NY, 10021, USA.
| | | | | | - Joaquin J Jimenez
- Department of Dermatology & Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | | | | | | | | | | | | | | | | | | | - Brian Berman
- Department of Dermatology & Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Shari B Goldfarb
- Department of Medicine, Memorial Sloan Kettering Cancer Center, 530 East 74th Street, New York, NY, 10021, USA. .,Department of Medicine, Weill Cornell Medical Center, New York, NY, USA. .,Breast Medicine Service Department of Medicine, Memorial Sloan-Kettering Cancer Center, 300 East 66th Street, New York, NY, 10065, USA.
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Silva GDB, Ciccolini K, Donati A, Hurk CVD. Scalp cooling to prevent chemotherapy-induced alopecia. An Bras Dermatol 2020; 95:631-637. [PMID: 32622629 PMCID: PMC7563013 DOI: 10.1016/j.abd.2020.03.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 03/20/2020] [Indexed: 02/07/2023] Open
Abstract
Chemotherapy-induced alopecia causes an important impact on cancer patients and its risk of persistence is currently a considerable issue in cancer survivors. Of the various interventions proposed for the prevention of chemotherapy-induced alopecia, scalp cooling has emerged as an effective and safe strategy. This paper aims to provide an overview on scalp cooling and chemotherapy-induced alopecia prevention.
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Affiliation(s)
| | - Kathryn Ciccolini
- Department of Hematology/Oncology, Mount Sinai Hospital, New York, NY, United States of America
| | - Aline Donati
- Department of Dermatology, Hospital do Servidor Público Municipal de São Paulo, São Paulo, SP, Brazil
| | - Corina van den Hurk
- R & D Department, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
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Skin Care During and After Radiotherapy and Anticancer Treatment. Radiat Oncol 2020. [DOI: 10.1007/978-3-319-52619-5_115-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Sonthalia S, Abhishek A. Tulipoid Hair: An Avoidable Addition to Metaphoric Trichoscopic Terminology. Int J Trichology 2019; 11:138-139. [PMID: 31360045 PMCID: PMC6580811 DOI: 10.4103/ijt.ijt_96_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Sidharth Sonthalia
- SKINNOCENCE: The Skin Clinic and Research Centre, Gurugram, Haryana, India
| | - Ashu Abhishek
- Department of Radiation Oncology, Fortis Memorial Research Institute, Gurugram, Haryana, India
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Bitto FF, König A, Phan-Brehm T, Vallbracht T, Koch JG, Schinköthe T, Wolfgarten M, Mahner S, Harbeck N, Würstlein R. EVA-Scalp: Evaluation of Patient Satisfaction with a Scalp Cooling Device to Prevent Chemotherapy-Induced Alopecia in Breast Cancer Patients. Breast Care (Basel) 2019; 15:171-177. [PMID: 32398986 DOI: 10.1159/000501393] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 06/06/2019] [Indexed: 01/01/2023] Open
Abstract
Purpose Scalp cooling (SC) offers a chance to reduce hair loss (HL), but patient satisfaction, the effect on well-being, as well as patient selection criteria have not been sufficiently assessed yet. Methods In the EVAScalp trial, SC was offered to 70 breast cancer patients who received chemotherapy between November 2015 and September 2018. For SC, the Paxman-Orbis-II System was used. Satisfaction was measured by a questionnaire evaluating the level of depression with the WHO-5 well-being index (WHO-5) plus questions addressing the patient's experiences and side effects using the SC device. To evaluate efficacy, documentation by photo, by a physician, and by an HL-diary was conducted. Results Regarding efficacy, a significant difference between chemotherapy regimens is seen. Anthracycline-based therapies led to a stop of SC in 71% of the patients, whereas taxane-based therapies without anthracyclines were associated with a high acceptance of SC, and 88% of patients with paclitaxel-based therapies continued SC throughout their chemotherapy. Overall, only 7.69% of the patients stopped because of side effects. As an indicator for quality of life, WHO-5 was higher (65.8%) in patients with successful SC compared to in patients who stopped SC because of HL or side effects (only 53.0%). The majority of patients (82.22%) with successful SC would recommend SC to other patients. Conclusions Patients tolerated SC as long as HL was successfully prevented. The well-being of patients with successful SC was significantly higher than that of patients who stopped SC prematurely. In general, SC is a promising approach and improves patient well-being, but there are still limitations to its utility depending on the chemotherapy regimen used.
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Affiliation(s)
- Franz-Ferdinand Bitto
- Breast Center, Department of Gynecology and Obstetrics and CCC Munich, University of Munich (LMU), Munich, Germany
| | - Alexander König
- Breast Center, Department of Gynecology and Obstetrics and CCC Munich, University of Munich (LMU), Munich, Germany
| | - Thuy Phan-Brehm
- Breast Center, Department of Gynecology and Obstetrics and CCC Munich, University of Munich (LMU), Munich, Germany
| | - Thomas Vallbracht
- Breast Center, Department of Gynecology and Obstetrics and CCC Munich, University of Munich (LMU), Munich, Germany
| | - Julian Gregor Koch
- Breast Center, Department of Gynecology and Obstetrics and CCC Munich, University of Munich (LMU), Munich, Germany
| | - Timo Schinköthe
- Breast Center, Department of Gynecology and Obstetrics and CCC Munich, University of Munich (LMU), Munich, Germany
| | | | - Sven Mahner
- Breast Center, Department of Gynecology and Obstetrics and CCC Munich, University of Munich (LMU), Munich, Germany
| | - Nadia Harbeck
- Breast Center, Department of Gynecology and Obstetrics and CCC Munich, University of Munich (LMU), Munich, Germany
| | - Rachel Würstlein
- Breast Center, Department of Gynecology and Obstetrics and CCC Munich, University of Munich (LMU), Munich, Germany
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Salzmann M, Marmé F, Hassel JC. Prophylaxis and Management of Skin Toxicities. Breast Care (Basel) 2019; 14:72-77. [PMID: 31798377 DOI: 10.1159/000497232] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Skin toxicity is a common problem not only when treating breast cancer but in all cancer types. Visible on the surface, these side effects come not just with burdening symptoms but also with stigmatization. With increasing diversity in therapeutic options, dermatologic side effects are also becoming increasingly complex and more challenging for the clinician. We reviewed the most common dermatologic side effects of current anticancer therapy, including toxicity induced by chemotherapy, targeted therapy, and immunotherapy. In particular, we focus on xerosis and pruritus, (acneiform) exanthema, hand-foot syndrome, nail toxicities, alopecia, and mucositis. We propose measures for the prevention and management of these side effects based on current literature. With high incidences in both chemotherapy and targeted therapy, prophylactic measures are crucial to reducing the incidence and severity of skin toxicity and therefore key to therapy adherence. Appropriate management of these toxicities will help avoid unnecessary treatment discontinuation.
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Affiliation(s)
- Martin Salzmann
- National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg.,Department of Dermatology, University Hospital Heidelberg, Heidelberg
| | - Frederik Marmé
- National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg.,Department of Obstetrics and Gynecology, University Hospital Heidelberg, Heidelberg, Germany
| | - Jessica C Hassel
- National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg.,Department of Dermatology, University Hospital Heidelberg, Heidelberg
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Gianotti E, Razzini G, Bini M, Crivellaro C, Righi A, Darecchio S, Lui S, Basiricò ML, Cocconi S, Cagossi K, Ferrari A, Artioli F. Scalp Cooling in Daily Clinical Practice for Breast Cancer Patients Undergoing Curative Chemotherapy: A Multicenter Interventional Study. Asia Pac J Oncol Nurs 2019; 6:277-282. [PMID: 31259224 PMCID: PMC6518988 DOI: 10.4103/apjon.apjon_4_19] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Objective: Chemotherapy-induced alopecia is a common and distressful side effect, especially among breast cancer patients. Scalp cooling (SC) can reduce hair loss during anthracycline- and taxane-based chemotherapy. This study assessed the effectiveness of SC in daily clinical practice in three Italian oncology units. Methods: From 2014 to 2016, we prospectively included 220 female early-stage breast cancer patients undergoing curative chemotherapy in combination with SC using the Paxman device. Effectiveness was defined as the severity of hair loss according to the Common Terminology Criteria for Adverse Events Version 4.0 as follows: Grade 0, no hair loss; Grade 1, <50% hair loss not requiring a wig; and Grade 2, ≥50% hair loss at each cycle and at completion of chemotherapy. The tolerability and safety were also evaluated. Results: The overall success rate of SC (hair loss Grade 0–1) was 68%. Severe hair loss was avoided in 89% of women receiving taxane-based chemotherapy and in 78% of women receiving both anthracyclines and taxanes. Among women undergoing anthracycline-based chemotherapy, 47% experienced hair preservation. SC was well tolerated, as only 20 patients discontinued SC for reasons other than hair loss. Conclusions: Our study confirmed that SC provides a reliable chance for breast cancer patients to keep their hair during taxane- and/or anthracycline-based chemotherapy.
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Affiliation(s)
- Emilia Gianotti
- Unit of Medical Oncology, Carpi Civil Hospital, Carpi, Medicine Department, Local Health Unit, Modena, Italy
| | - Giorgia Razzini
- Unit of Medical Oncology, Carpi Civil Hospital, Carpi, Medicine Department, Local Health Unit, Modena, Italy
| | - Manuela Bini
- Unit of Medical Oncology, Carpi Civil Hospital, Carpi, Medicine Department, Local Health Unit, Modena, Italy
| | - Caterina Crivellaro
- Unit of Medical Oncology, Carpi Civil Hospital, Carpi, Medicine Department, Local Health Unit, Modena, Italy
| | - Angela Righi
- Unit of Medical Oncology, Carpi Civil Hospital, Carpi, Medicine Department, Local Health Unit, Modena, Italy
| | - Simona Darecchio
- Oncology Unit, Guastalla Civil Hospital, Guastalla, Medicine Department Local Healt Unit, Reggio Emilia, Italy
| | - Stefania Lui
- Oncology Unit, Guastalla Civil Hospital, Guastalla, Medicine Department Local Healt Unit, Reggio Emilia, Italy
| | | | - Silvia Cocconi
- Oncology Unit, Parma Hospital, University of Parma, Parma, Italy
| | - Katia Cagossi
- Unit of Medical Oncology, Carpi Civil Hospital, Carpi, Medicine Department, Local Health Unit, Modena, Italy
| | - Alessia Ferrari
- Unit of Medical Oncology, Carpi Civil Hospital, Carpi, Medicine Department, Local Health Unit, Modena, Italy
| | - Fabrizio Artioli
- Unit of Medical Oncology, Carpi Civil Hospital, Carpi, Medicine Department, Local Health Unit, Modena, Italy
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Prochilo T, Huscher A, Andreis F, Mirandola M, Zaina E, Pomentale B, Pedrali C, Zanotti L, Mutti S, Zaniboni A. Hair Loss Prevention by a Scalp Cooling Device in Early Breast Cancer Patients: The Poliambulanza Preliminary Experience. Rev Recent Clin Trials 2019; 14:66-71. [PMID: 30457055 DOI: 10.2174/1574887113666181120111104] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 11/08/2018] [Accepted: 11/09/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND The most effective agents in the treatment of breast cancer have a common side effect, the hair loss. Some studies reported a reduction of hair loss with the use of the scalp cooling device. Indeed, it decreases the drug accumulation in the hair follicles. We report our preliminary experience with a scalp cooling device in reducing chemotherapy-induced alopecia and related distress in breast cancer patients undergoing adjuvant chemotherapy. METHODS Hair loss grading and treatment tolerability were evaluated during chemotherapy every 21 days and 3 weeks after the last cycle of chemotherapy via Dean's scale by patients and operators and a comfort analogic scale by patients. We administered the Hospital Anxiety and Depression Scale questionnaire at the baseline and at the end of treatment to assess the distress related to chemotherapy- induced alopecia. RESULTS Among the 46 patients identified, 27 accepted the device. The eligible chemotherapy regimens included docetaxel+cyclophosphamide (TC), doxorubicin+cyclophosphamide (AC) and paclitaxel (P) weekly+trastuzumab (T). 24 pts (89%) completed the treatment; 3 pts (11%) treated with AC prematurely interrupted use of the scalp-cooling device due to inefficacy. After the last cycle of chemotherapy, the number of patient who perceived a HL < grade 2 was 16 (59%). The hair retention reported by operators has been higher (78%). 81.5% of patients well tolerated the treatment. CONCLUSION In our study, the scalp-cooling device reduced chemotherapy-induced alopecia in taxane- based chemotherapy. Furthermore, it suggests a discordance in hair loss perception between patients and operators.
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Affiliation(s)
| | | | | | - Mara Mirandola
- Medical Oncology Unit, Fondazione Poliambulanza, Brescia, Italy
| | | | | | - Chiara Pedrali
- Medical Oncology Unit, Fondazione Poliambulanza, Brescia, Italy
| | - Laura Zanotti
- Medical Oncology Unit, Fondazione Poliambulanza, Brescia, Italy
| | - Stefano Mutti
- Surgery Department, Fondazione Poliambulanza, Brescia, Italy
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Affiliation(s)
- Subrata S Malakar
- Department of Dermatology, Rita Skin Foundation, Kolkata, West Bengal, India
| | - Purva Ranjit Mehta
- Department of Dermatology, Rita Skin Foundation, Kolkata, West Bengal, India
| | - Surit S Malakar
- Department of Dermatology, Rita Skin Foundation, Kolkata, West Bengal, India
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Gunawan S, Broeke CT, Ven PVD, Arnoldussen M, Kaspers G, Mostert S. Parental Experiences with Chemotherapy-Induced Alopecia among Childhood Cancer Patients in Indonesia. Asian Pac J Cancer Prev 2017; 17:1717-23. [PMID: 27221843 DOI: 10.7314/apjcp.2016.17.4.1717] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study assessed parental experiences with chemotherapy-induced alopecia among children with cancer treated at an Indonesian academic hospital. MATERIALS AND METHODS Fifty parents of childhood cancer patients were interviewed using semi-structured questionnaires. RESULTS The moment that hair fell out was the moment that parents (84%) had to admit their child had cancer. Alopecia was a traumatizing painful experience (46%). Active strategies to hide alopecia, mainly hats, were used by 66% of children, while 34% never covered their bald head. If money had not been an issue, 40% would use another strategy. Alopecia made children limit outdoor daily activities (78%) and engagement with others (60%). Significantly more children from high-educated (95%) than low-educated (60%) parents received sympathy from other people (P=0.012). Significantly more Christian (29%) than Muslim (0%) families confirmed that alopecia lowered the quality of life (P=0.046). Most parents (82%) had no prior plans about alopecia management, yet for significantly more girls (26%) than boys (0%) such plans existed (P=0.044). Parents received most information about alopecia from other parents (66%). Parents (92%) needed more alopecia education from doctors. Of all school-attending children, 53% were bullied and 47% did not want to attend school due to alopecia. Significantly more high-educated than low-educated families received pity from teachers and pupils (94% vs. 0%, P=0.004), and acceptance by pupils (81% vs. 0%, P=0.021). CONCLUSIONS Alopecia is a severe, far-stretching side-effect of chemotherapy with physical, psychological and social consequences for children and parents. Parents should be better informed about occurrence and impact of alopecia. Extra attention is required to facilitate children's return to school. Health- care providers should facilitate optimal supportive care through open dialogue and provision of educational materials for parents, children and their community.
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Affiliation(s)
- Stefanus Gunawan
- Department of Pediatrics, Kandou Hospital, Manado, Indonesia, E-mail :
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Tasaki N, Minematsu T, Mugita Y, Ikeda SI, Nakagami G, Sanada H. Telogen elongation in the hair cycle of ob/ob mice. Biosci Biotechnol Biochem 2016; 80:74-9. [DOI: 10.1080/09168451.2015.1069693] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Abstract
Alopecia impairs the physical and mental health of patients. We have previously shown that 8-week-old ob/ob mice have no reactivity to depilation, which is a stimulus that induces anagen transition in normal mice, while no hair cycle abnormalities have been reported in other studies until mice reach 7 weeks of age. Therefore, we hypothesized that ob/ob mice have abnormalities in hair cycle progression beyond 7 weeks of age. We examined 6- to 24-week-old ob/ob and 6- to 10-week-old normal mice. After acclimation, the dorsal skin was harvested and the hair cycle phase was identified histologically and immunohistochemically. Normal mice showed catagen–telogen and telogen–anagen transitions at 6 and 8–9 weeks old, respectively. In contrast, the anagen–catagen transition was observed in 7-week-old mice and the telogen phase was maintained from 10 to 24 weeks in most ob/ob mice. These results suggests that ob/ob mice are a possible model animal for telogen effluvium.
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Affiliation(s)
- Natsumi Tasaki
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Takeo Minematsu
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yuko Mugita
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Shin-ichi Ikeda
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Gojiro Nakagami
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiromi Sanada
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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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.
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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
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Efficacy and tolerability of two scalp cooling systems for the prevention of alopecia associated with docetaxel treatment. Support Care Cancer 2013; 21:2565-73. [PMID: 23636645 DOI: 10.1007/s00520-013-1804-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Accepted: 03/25/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE Chemotherapy-induced alopecia is very distressing for a patient and may have an impact on treatment decisions. On docetaxel-based therapy, alopecia occurs in a substantial proportion of patients. We aimed to investigate whether two different methods of scalp cooling can prevent hair loss. METHODS In this open-label, prospective, nonrandomized trial, patients with solid tumors receiving docetaxel in a palliative setting were allocated according to patients' preference to short-term cooling (over 45 min postinfusion) with a Paxman PSC-2 machine (PAX), with cold cap (CC), or no cooling. The combined endpoint was alopecia World Health Organisation (WHO) III or IV or the necessity to wear a wig. Study identifier is Clinicaltrials.gov NCT01008774. RESULTS Two hundred thirty-eight patients were included in the trial (128 patients PAX, 71 CC, and 39 no cooling). Number of cycles (median 4) and median docetaxel doses were similar across groups (55-60 mg/day on weekly therapy, 135-140 mg/day on 3-weekly therapy). Alopecia occurred with PAX, CC, and no cooling under 3-weekly docetaxel in 23, 27, and 74% and under weekly docetaxel in 7, 8, and 17%, respectively. Overall, cooling (PAX and CC combined) reduced risk of alopecia by 78% (hazard ratio 0.22; 95% confidence interval 0.12 to 0.41). CC and PAX prophylaxis led to the same degree of prevention of alopecia. Adverse events (AE) were reported in 5% (most frequently, sensation of cold), and 30 patients (13%) discontinued cooling measures after cycle 1. CONCLUSIONS In this first comparison published to date, both PAX and CC offer efficacious protection against hair loss, in particular when docetaxel is administered in a 3-weekly interval.
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23
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Cakir E. Is prediabetes risk factor for hair loss? Med Hypotheses 2012; 79:879. [PMID: 23073120 DOI: 10.1016/j.mehy.2012.09.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2012] [Accepted: 09/20/2012] [Indexed: 10/27/2022]
Abstract
In the recent hypothesis that hair loss might be a manifestation of metabolic abnormalities particularly hyperglicemia. It has been reported various environmental risk factors affecting hair loss. There is growing evidence on the relationship between prediabetes and worse metabolic profile. However, there are few studies about the association between hair loss, metabolic disorder and diabetes. Therefore patients that admitted the hospital with hair loss should be screened for diabetes mellitus and prediabetes. In these subjects prediabetes increasing cardiovascular disease risk and worse metabolic profile have to be determined and the patients with hair loss should be followed up for cardiovascular disease risk. It has been warranted further studies to evaluate the relationship between prediabetes and hair loss.
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Affiliation(s)
- Evrim Cakir
- Department of Endocrinology and Metabolic Diseases, Amasya Sabuncuoglu Serefettin Hospital, Amasya, Turkey.
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ZANNINI L, VERDERAME F, CUCCHIARA G, ZINNA B, ALBA A, FERRARA M. ‘My wig has been my journey's companion’: perceived effects of an aesthetic care programme for Italian women suffering from chemotherapy-induced alopecia. Eur J Cancer Care (Engl) 2012; 21:650-60. [DOI: 10.1111/j.1365-2354.2012.01337.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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