Among patients with breast cancer receiving neoadjuvant or adjuvant chemotherapy, those who underwent scalp cooling were significantly less likely to experience chemotherapy-induced hair loss than those who did not receive scalp cooling, a study published in JAMA has shown.1

Although scalp cooling devices have been used to prevent alopecia caused by chemotherapy, its efficacy has not been established in a randomized clinical trial. Therefore, researchers sought to evaluate the efficacy and safety of scalp cooling compared with no treatment in women with breast cancer undergoing chemotherapy.

For the multicenter study ( Identifier: NCT01986140), investigators enrolled 182 patients receiving neoadjuvant or adjuvant chemotherapy with a taxane, anthracycline, or both, at 7 sites in the United States and randomly assigned them 2:1 to undergo scalp cooling with Orbis Paxman Hair Loss Prevention System or control. Their average age was approximately 53 years and 36% and 64% received anthracycline-based and taxane-based chemotherapy, respectively.

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The interim analysis showed that 50.5% (95% CI, 40.7-60.4) of the 95 evaluable women in the scalp cooling experienced successful hair preservation, defined as no hair loss or less than 50% hair loss without requiring a wig at the end of 4 cycles of chemotherapy, compared with 0% (95% CI, 0-7.6). The investigators stopped the trial early due to scalp cooling being superior to no treatment (P =.0061).

Notably, there were no statistically significant differences in changes in quality of life from baseline to cycle 4 of chemotherapy between the 2 groups. 

Investigators observed 54 adverse events in the cooling group. All were grade 1 to 2 toxicities. There were no serious adverse device events.

The findings suggest that scalp cooling is more likely to prevent chemotherapy-induced alopecia in patients with breast cancer than no treatment; however, further research is necessary to evaluate its long-term efficacy and safety.


1. Nangia J, Wang T, Osborne C, et al. Effect of a scalp cooling device on alopecia in women undergoing chemotherapy for breast cancer. JAMA. 2017;317(6):596-605.