Interventions for Preventing Chemotherapy-Induced Alopecia: A Systematic Review and Network Meta-analysis of Randomized Controlled Trials

Cancer Nurs. 2021 Nov-Dec;44(6):E567-E577. doi: 10.1097/NCC.0000000000000899.


Background: Chemotherapy-induced alopecia (CIA) is a common adverse effect among patients undergoing chemotherapy. Patients experiencing CIA suffer psychological distress and even refuse or discontinue chemotherapy. A variety of interventions have been applied to prevent CIA. However, the best intervention option remains unknown.

Objective: To evaluate and determine the comparative effects of all available interventions for preventing CIA.

Methods: A comprehensive literature search of four English and 3 Chinese electronic databases was performed to identify potential studies from database inception to August 2018. Two reviewers conducted data selection, data extraction, and risk of bias assessment independently. The consistency model was used to conduct a network meta-analysis based on a frequentist framework to evaluate the relative effects of different interventions. Rankings of interventions were evaluated by the surface under the cumulative ranking curve values.

Results: Seventeen eligible trials including 1378 patients were included. Scalp cooling (odds ratio, 0.13; 95% confidence interval, 0.07-0.25) and scalp compression (odds ratio, 0.13; 95% confidence interval, 0.03-0.52) had significant effects relative to usual care. Ranking of efficacy indicated that scalp cooling was the most effective, followed by scalp compression with tourniquets, topical Chinese medicinal herbs, oral Chinese medicinal herbs, minoxidil, and usual care.

Conclusion: The results of this study indicate that scalp cooling is the most effective method to prevent CIA during chemotherapy.

Implications for practice: Our results could provide a reference to prevent CIA. Updated studies with high quality, sufficient sample sizes, and direct comparison between interventions are needed in the future.

Publication types

  • Meta-Analysis
  • Systematic Review

MeSH terms

  • Alopecia* / chemically induced
  • Alopecia* / prevention & control
  • Antineoplastic Agents* / adverse effects
  • Humans
  • Network Meta-Analysis
  • Randomized Controlled Trials as Topic


  • Antineoplastic Agents