There are many factors that steer which patients are suitable for scalp cooling, such as patients’ condition (physical and psychological), types and stages of cancer, adjuvant or palliative chemotherapy, types and dosage of chemotherapeutic agents used, patient motivation, etc. Please consult your doctor or oncology nurse to find out whether scalp cooling is suitable for you.
a) Scalp cooling with DigniCap™ can be used on patients receiving treatment (both adjuvant and palliative) for cancers such as breast, ovarian/endometrial, prostate, lung, esophageal/stomach and colon.
b) Scalp cooling can be used on a wide selection of chemotherapy regimens, particularly when anthracyclines or taxanes are used. The results are higher in single-drug therapy than in combination therapy. (Please see the list of recommended drug regimens and cooling time for the DigniCap™ system.)
Who should not use scalp cooling?
a)
Scalp cooling should be avoided in patients with hematological malignancies with hematogenic metastases (e.g. myeloma, leukemia, lymphoma) due to possible risk of scalp metastases. However, in certain cases it may feel appropriate to offer scalp cooling to some of these patients for reasons of quality of life.
b)
Scalp cooling is not recommended in cases of migraine and violent aversion to cold.
c)
Scalp cooling is not recommended for some chemotherapy treatments where the drug stays in the body for a long time: for example, continuous treatment through a pump for many hours.
d)
Scalp cooling is not recommended in patients who have impaired liver function or the presence of liver metastases, as the hair-protective effect of scalp cooling may be low due to the longer time it takes to eliminate the drug.
Scalp metastases
Some clinicians may be skeptical about the use of scalp cooling with treatment that aims to cure the cancer, as they fear that cancer cells that may be seeded in the scalp may survive the chemotherapy, which may in turn induce skin scalp metastases. Such metastases are rare and occur in about
1 in 2000 breast cancer patients (Wollina 2004). However, some hospitals may not offer scalp cooling due to this fear. In fact, there is no evidence that scalp cooling carries an increased risk of scalp metastasis. In fact there are more studies that reported no increased risk in incidence of scalp metastases and at follow-up (Parker 1987, Giacconne 1988, Ron 1997, LeMenager 1997, Christodoulou 2002, Protière 2002, Ridderheim 2003). A study in
France in which scalp cooling has been practised in over two decades, no increase in the incidence rate of scalp metastases has been observed (LeMenager, 1997). It may be of interest that in one Greek study (Christodoulou 2002), one patient with scalp metastases did respond to treatment and her hair was preserved. In
Scandinavia, the data of 2249 patients treated with DigniCap™ in various hospitals were collected and followed up since 2001, with only one reported case of scalp metastasis, and this was a patient who has metastases in most parts of the body. Similarly, none of the 74 patients (including 8 patients with Hodgkin’s lymphoma) in a study (Ridderheim 2003) on the DigniCap™ system with an average follow-up of 15 months developed skin scalp metastases.
Most recently, a multicenter study on 911 patients treated with scalp cooling show no increase in incidence of skin scalp metastases compared to non-treated patients (Spaëth 2008). The implementation of routine scalp cooling was recommended by the authors, especially in cancers without tendencies to bone metastases.
The need for hair preservation far outweighs the risk, and the fear of scalp metastases is not justified (Breed 2004). For many patients NOT losing their hair may be the most important aspect of their treatment. The risk of scalp cooling, if any, is insignificant. However, we need to look into the long-term adverse consequences and not put certain patients at unnecessary risk, even though the risk may be remote.
Compatible chemotherapy drugs to scalp cooling: