Efficacy of scalp cooling for prevention of chemotherapy induced alopecia: a systematic review and meta-analysis.

OBJECTIVE

The aim of the study was to compare the risk of chemotherapy induced alopecia among patients with scalp cooling therapy, compared to those that did not receive scalp cooling.

MATERIALS AND METHODS

A systematic search was conducted in the PubMed, Scopus, Cochrane Database of Systematic Reviews and Google scholar databases. Studies, preferably randomized controlled trials, that compared scalp cooling with no scalp cooling (control) for risk of alopecia or hair loss in patients undergoing chemotherapy were considered for inclusion. The strength of association was presented in the form of pooled adjusted relative risk (RR) for categorical outcomes and weighted mean difference (WMD) for continuous outcomes. Statistical analysis was done using STATA version 16.0.

RESULTS

A total of 14 articles were identified, of which 9 were included in the meta-analysis and for the remaining 5 articles, the findings were synthesized descriptively. Compared to control group patients, those that received scalp cooling had 41% lower risk of alopecia [RR 0.59, 95% CI: 0.53, 0.66]. The overall quality of pooled evidence for the risk of alopecia was judged "moderate". There were no differences in the anxiety score [WMD 0.57, 95% CI: -0.55, 1.69], depression score [WMD 0.31, 95% CI: -1.19, 1.80], score reflecting emotional functioning [WMD 0.06, 95% CI: -1.37, 1.49] and social functioning [WMD -8.37, 95% CI: -25.7, 8.93] among the two groups of patients. The pooled evidence suggests that around 66% (95% CI: 37-95%) of the subjects reported some discomfort with use of scalp cooling system. The commonly reported complaints included headache, scalp and neck pain, discomfort due to chill, nausea/vomiting and dizziness.

CONCLUSIONS

Findings suggest that the use of scalp cooling, compared to no scalp cooling, reduces the risk of significant hair loss. The acceptability of this cooling system might be limited by a high incidence of reported complaints.