Health Problem: Chemotherapy-induced alopecia (CIA) is a common and well-known side effect of chemotherapy, affecting approximately 65% of patients who undergo chemotherapy for cancer. CIA is attributed to the cytotoxic effects of chemotherapy drugs on the matrix cells of the hair follicles during hair growth phases. CIA has been associated with reduced quality of life, depression, and poor body image.

Technology Description: Scalp cooling devices and caps are intended to reduce the likelihood of hair loss from chemotherapy by causing vasoconstriction, thereby reducing the local uptake of chemotherapeutic agent, the metabolic rate of the hair follicle, or both. Older studies employ ice packs secured to the scalp with bandages or ice packs fashioned into caps that fit over the scalp. Commercially available precooled nonautomated caps are not subject to Food and Drug Administration (FDA) regulation or prescription and patients can rent them directly from the manufacturers. Newer technologies cleared by the FDA for scalp cooling systems are self-contained, with built-in temperature sensors that cool and circulate a glycol-based fluid through channels in a cap, allowing for continuous, uninterrupted cooling throughout the treatment session.

Controversy: Scalp cooling devices have been investigated for the prevention of CIA since the 1970s, and cooling is commonly used in Europe. Although scalp cooling is the most widely used method for the prevention of CIA, its efficacy is variable and can be unpredictable. Scalp cooling devices have only recently gained regulatory clearance in the United States. Furthermore, there is concern that scalp cooling may be associated with scalp metastasis due to lack of chemotherapy reaching tumor cells seeded in the scalp.

Key Questions:

For adults undergoing chemotherapy:

  • What is the evidence regarding the efficacy of scalp cooling devices for the prevention of CIA compared with no treatment, sham, or other active treatment?
  • What is the evidence regarding the safety of scalp cooling devices for the prevention of CIA?
  • Have definitive patient selection criteria been identified for scalp cooling for prevention of CIA?

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