Impact of scalp cooling on chemotherapy-induced alopecia, wig use and hair growth of patients with cancer

Eur J Oncol Nurs. 2013 Oct;17(5):536-40. doi: 10.1016/j.ejon.2013.02.004. Epub 2013 Apr 6.


Introduction: Cytotoxic therapy for patients with cancer frequently induces reversible, but long-lasting alopecia which might be prevented by scalp cooling. This study evaluates the effectiveness of scalp cooling with respect to the severity of chemotherapy-induced alopecia (CIA) and the purchase and use of wigs and head covers.

Materials and methods: In this observational study, scalp-cooled patients (n = 160) were compared with non scalp-cooled patients (n = 86) with several types of cancer. Patients were enrolled in 15, mostly general hospitals prior to taxane and/or anthracycline-based chemotherapy. Patients completed four questionnaires between the start and one year after the last chemotherapy.

Results: Severity of CIA, and purchasing and actually wearing wigs and head covers were significantly lower among scalp-cooled than non scalp-cooled patients. Overall, scalp cooling reduced the use of wigs and head covers by 40%. Among 84 scalp-cooled patients who purchased a wig (53%), only 52 patients actually wore it (62%), and they just wore it intensively (86% daily) for less than six months (80%). Especially young patients camouflaged CIA with a head cover instead of a wig.

Discussion: The relatively long duration of CIA, the wish of many patients to camouflage or rather prevent it and the 40% reduction for head covering by scalp cooling, makes it a worthwhile supportive intervention. However, (cost-) effectiveness can be improved. Many scalp-cooled patients purchased a wig unnecessarily.

Keywords: Cancer; Chemotherapy-induced alopecia; Hair growth; Hair loss; Scalp cooling; Wig.

Publication types

  • Comparative Study
  • Multicenter Study
  • Observational Study

MeSH terms

  • Adult
  • Alopecia / chemically induced*
  • Alopecia / prevention & control*
  • Antineoplastic Combined Chemotherapy Protocols / adverse effects*
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use
  • Chi-Square Distribution
  • Female
  • Follow-Up Studies
  • Hair / growth & development
  • Humans
  • Hypothermia, Induced / methods*
  • Male
  • Middle Aged
  • Neoplasms / drug therapy
  • Neoplasms / pathology
  • Netherlands
  • Prospective Studies
  • Reference Values
  • Scalp*
  • Treatment Outcome