Impact of alopecia and scalp cooling on the well-being of breast cancer patients

Objective: Chemotherapy-induced alopecia, a common and distressing side effect of chemotherapy, may be prevented by scalp cooling, which reduces toxicity of cytostatics in hair root cells. This is the first study designed to assess the effect of scalp cooling on well-being. Methods: A prospective multi-centre study was performed in 13 hospitals. Breast cancer patients treated with (N=98) and without (N=168) scalp cooling completed questionnaires (EORTC QLQ-C30 and EORTC-QLQ-BR23, BIS, MBA, HADS) before chemotherapy, and three weeks and six months after the last chemotherapy cycle. Results: Scalp cooling was effective in 52% of the cases. Alopecia was considered among the most distressing problems at all three moments of measurement. A trend towards higher well-being was found in successfully scalp-cooled patients, as indicated by a general better health-related quality of life and better body image, whereas unsuccessfully scalp-cooled patients reported lowest well-being. Conclusions: Scalp cooling contributes not only to the well-being of successfully scalp-cooled patients but also seems to cause additional distress when patients lose their hair despite scalp cooling. This might be related to disappointment due to alopecia despite scalp cooling or possibly to a general higher biological availability of cytostatics. We recommend additional support for patients when scalp cooling is not successful and to spend more effort to maximise the effectiveness of scalp cooling. Copyright © 2009 John Wiley & Sons, Ltd.