A Clinical and Biological Guide for Understanding Chemotherapy-Induced Alopecia and its Prevention

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Abstract

Chemotherapy‐induced alopecia (CIA) is the most visibly distressing side effect of commonly administered chemotherapeutic agents. Because psychological health has huge relevance to lifestyle, diet, and self‐esteem, it is important for clinicians to fully appreciate the psychological burden that CIA can place on patients. Here, for the first time to our knowledge, we provide a comprehensive review encompassing the molecular characteristics of the human hair follicle (HF), how different anticancer agents damage the HF to cause CIA, and subsequent HF pathophysiology, and we assess known and emerging prevention modalities that have aimed to reduce or prevent CIA. We argue that, at present, scalp cooling is the only safe and U.S. Food and Drug Administration‐cleared modality available, and we highlight the extensive available clinical and experimental (biological) evidence for its efficacy. The likelihood of a patient that uses scalp cooling during chemotherapy maintaining enough hair to not require a wig is approximately 50%. This is despite different types of chemotherapy regimens, patient‐specific differences, and possible lack of staff experience in effectively delivering scalp cooling. The increased use of scalp cooling and an understanding of how to deliver it most effectively to patients has enormous potential to ease the psychological burden of CIA, until other, more efficacious, equally safe treatments become available.

Implications for Practice.
Chemotherapy‐induced alopecia (CIA) represents perhaps the most distressing side effect of chemotherapeutic agents and is of huge concern to the majority of patients. Scalp cooling is currently the only safe option to combat CIA. Clinical and biological evidence suggests improvements can be made, including efficacy in delivering adequately low temperature to the scalp and patient‐specific cap design. The increased use of scalp cooling, an understanding of how to deliver it most effectively, and biological evidence‐based approaches to improve its efficacy have enormous potential to ease the psychological burden of CIA, as this could lead to improvements in treatment and patient quality‐of‐life.
LanguageEnglish
Pages84-96
Number of pages13
JournalOncologist
Volume23
Issue number1
Early online date26 Sep 2017
DOIs
Publication statusPublished - Jan 2018

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Alopecia
Scalp
Drug Therapy
Hair Follicle
Psychology
United States Food and Drug Administration
Self Concept
Antineoplastic Agents
Hair
Life Style
Quality of Life
Diet
Temperature

Cite this

@article{8ecc0aae5daa4dc0b2462d7ecf21a788,
title = "A Clinical and Biological Guide for Understanding Chemotherapy-Induced Alopecia and its Prevention",
abstract = "Chemotherapy‐induced alopecia (CIA) is the most visibly distressing side effect of commonly administered chemotherapeutic agents. Because psychological health has huge relevance to lifestyle, diet, and self‐esteem, it is important for clinicians to fully appreciate the psychological burden that CIA can place on patients. Here, for the first time to our knowledge, we provide a comprehensive review encompassing the molecular characteristics of the human hair follicle (HF), how different anticancer agents damage the HF to cause CIA, and subsequent HF pathophysiology, and we assess known and emerging prevention modalities that have aimed to reduce or prevent CIA. We argue that, at present, scalp cooling is the only safe and U.S. Food and Drug Administration‐cleared modality available, and we highlight the extensive available clinical and experimental (biological) evidence for its efficacy. The likelihood of a patient that uses scalp cooling during chemotherapy maintaining enough hair to not require a wig is approximately 50{\%}. This is despite different types of chemotherapy regimens, patient‐specific differences, and possible lack of staff experience in effectively delivering scalp cooling. The increased use of scalp cooling and an understanding of how to deliver it most effectively to patients has enormous potential to ease the psychological burden of CIA, until other, more efficacious, equally safe treatments become available.Implications for Practice.Chemotherapy‐induced alopecia (CIA) represents perhaps the most distressing side effect of chemotherapeutic agents and is of huge concern to the majority of patients. Scalp cooling is currently the only safe option to combat CIA. Clinical and biological evidence suggests improvements can be made, including efficacy in delivering adequately low temperature to the scalp and patient‐specific cap design. The increased use of scalp cooling, an understanding of how to deliver it most effectively, and biological evidence‐based approaches to improve its efficacy have enormous potential to ease the psychological burden of CIA, as this could lead to improvements in treatment and patient quality‐of‐life.",
keywords = "Chemotherapy-induced alopecia, Hair loss, Chemotherapy, Scalp cooling, Side effects, Toxicity, Hair follicle, Cell models, Prevention, Safety",
author = "Christopher Dunnill and {Al Tameemi}, Wafaa and Andrew Collett and Iain Haslam and Nikolaos Georgopoulos",
year = "2018",
month = "1",
doi = "10.1634/theoncologist.2017-0263",
language = "English",
volume = "23",
pages = "84--96",
journal = "Oncologist",
issn = "1083-7159",
publisher = "AlphaMed Press",
number = "1",

}

TY - JOUR

T1 - A Clinical and Biological Guide for Understanding Chemotherapy-Induced Alopecia and its Prevention

AU - Dunnill,Christopher

AU - Al Tameemi,Wafaa

AU - Collett,Andrew

AU - Haslam,Iain

AU - Georgopoulos,Nikolaos

PY - 2018/1

Y1 - 2018/1

N2 - Chemotherapy‐induced alopecia (CIA) is the most visibly distressing side effect of commonly administered chemotherapeutic agents. Because psychological health has huge relevance to lifestyle, diet, and self‐esteem, it is important for clinicians to fully appreciate the psychological burden that CIA can place on patients. Here, for the first time to our knowledge, we provide a comprehensive review encompassing the molecular characteristics of the human hair follicle (HF), how different anticancer agents damage the HF to cause CIA, and subsequent HF pathophysiology, and we assess known and emerging prevention modalities that have aimed to reduce or prevent CIA. We argue that, at present, scalp cooling is the only safe and U.S. Food and Drug Administration‐cleared modality available, and we highlight the extensive available clinical and experimental (biological) evidence for its efficacy. The likelihood of a patient that uses scalp cooling during chemotherapy maintaining enough hair to not require a wig is approximately 50%. This is despite different types of chemotherapy regimens, patient‐specific differences, and possible lack of staff experience in effectively delivering scalp cooling. The increased use of scalp cooling and an understanding of how to deliver it most effectively to patients has enormous potential to ease the psychological burden of CIA, until other, more efficacious, equally safe treatments become available.Implications for Practice.Chemotherapy‐induced alopecia (CIA) represents perhaps the most distressing side effect of chemotherapeutic agents and is of huge concern to the majority of patients. Scalp cooling is currently the only safe option to combat CIA. Clinical and biological evidence suggests improvements can be made, including efficacy in delivering adequately low temperature to the scalp and patient‐specific cap design. The increased use of scalp cooling, an understanding of how to deliver it most effectively, and biological evidence‐based approaches to improve its efficacy have enormous potential to ease the psychological burden of CIA, as this could lead to improvements in treatment and patient quality‐of‐life.

AB - Chemotherapy‐induced alopecia (CIA) is the most visibly distressing side effect of commonly administered chemotherapeutic agents. Because psychological health has huge relevance to lifestyle, diet, and self‐esteem, it is important for clinicians to fully appreciate the psychological burden that CIA can place on patients. Here, for the first time to our knowledge, we provide a comprehensive review encompassing the molecular characteristics of the human hair follicle (HF), how different anticancer agents damage the HF to cause CIA, and subsequent HF pathophysiology, and we assess known and emerging prevention modalities that have aimed to reduce or prevent CIA. We argue that, at present, scalp cooling is the only safe and U.S. Food and Drug Administration‐cleared modality available, and we highlight the extensive available clinical and experimental (biological) evidence for its efficacy. The likelihood of a patient that uses scalp cooling during chemotherapy maintaining enough hair to not require a wig is approximately 50%. This is despite different types of chemotherapy regimens, patient‐specific differences, and possible lack of staff experience in effectively delivering scalp cooling. The increased use of scalp cooling and an understanding of how to deliver it most effectively to patients has enormous potential to ease the psychological burden of CIA, until other, more efficacious, equally safe treatments become available.Implications for Practice.Chemotherapy‐induced alopecia (CIA) represents perhaps the most distressing side effect of chemotherapeutic agents and is of huge concern to the majority of patients. Scalp cooling is currently the only safe option to combat CIA. Clinical and biological evidence suggests improvements can be made, including efficacy in delivering adequately low temperature to the scalp and patient‐specific cap design. The increased use of scalp cooling, an understanding of how to deliver it most effectively, and biological evidence‐based approaches to improve its efficacy have enormous potential to ease the psychological burden of CIA, as this could lead to improvements in treatment and patient quality‐of‐life.

KW - Chemotherapy-induced alopecia

KW - Hair loss

KW - Chemotherapy

KW - Scalp cooling

KW - Side effects

KW - Toxicity

KW - Hair follicle

KW - Cell models

KW - Prevention

KW - Safety

UR - http://theoncologist.alphamedpress.org/

U2 - 10.1634/theoncologist.2017-0263

DO - 10.1634/theoncologist.2017-0263

M3 - Article

VL - 23

SP - 84

EP - 96

JO - Oncologist

T2 - Oncologist

JF - Oncologist

SN - 1083-7159

IS - 1

ER -