Background: Chemotherapy-induced alopecia (CIA) is a common yet unintended side-effect of chemotherapy treatment with severe psychological impacts for cancer patients. Scalp cooling (SC) is the only currently available intervention to combat CIA. An audit into the efficacy of SC for multiple different chemotherapies was conducted using real-world outcomes of patients using SC during chemotherapy. Methods: The Dutch Scalp Cooling Registry collected data on 7424 scalp-cooled patients between 2006-2019. Nurses and patients completed questionnaires on patient characteristics, chemotherapy type, and SC protocol. Patient-reported primary outcomes at the start of the final SC session included head cover (HC) use (e.g. wig/scarf) as a proxy for patient satisfaction with SC and WHO score for alopecia (0-3 = no hair loss up to total alopecia) as a measure of SC success. Statistical analysis was conducted between primary outcomes and various parameters. Exhaustive logistic regression analysis stratified by chemotherapy regimen was implemented to examine characteristics and interactions associated with the SC result. Results: Overall, 56% of patients (n = 4191) did not wear a HC and 53% (n = 3784/7183) reported minimal hair loss (WHO score 0/1) at the start of their final treatment. Outcomes were drug regimen- and dose-dependent. Parameters influencing primary outcomes were variable between drug categories. For non-gender specific cancers, gender played no statistically significant role in HC use, nor did WHO score. HC was shown to be a good surrogate for satisfaction with SC. Implications for practise: Scalp cooling is effective for many patients. The comprehensive audit and robust methodology for evaluating the drug and dose specific determinants of SC efficacy revealed no indications for changes in daily practice. However, variation between patient subgroups suggests that success factors are currently being overlooked. As no correlation was identified between the determinants explaining HC use and WHO score outcomes, new methods for evaluation are warranted. In addition, steps need to be taken to improve information provisions on SC for chemotherapy patients to expand availability, accessibility and inclusivity of services.