Scalp cooling therapy in chemotherapy-induced alopecia: addressing variability in cooling duration and efficacy

Chemotherapy-induced alopecia (CIA) is a distressing side effect of cancer treatment with significant psychosocial consequences. Scalp cooling therapy (SCT) reduces the risk of CIA, but variability in pre- and post-infusion cooling durations limits its standardization and broader implementation. This review aims to examine current practices, identify factors contributing to variation, and explore strategies for optimizing SCT protocols.

We conducted a narrative review of published literature on SCT, including studies evaluating efficacy across chemotherapy regimens, SCT duration, patient factors such as hair type and race, and institutional barriers. We also reviewed studies assessing innovations aimed at reducing chair time and improving feasibility of SCT delivery in diverse clinical settings.

Pre-cooling durations typically range from 5-30 min, while post-cooling times vary from 15 min to 4 h, often without clear evidence for longer durations. Taxane-based regimens show higher hair preservation success compared to anthracyclines. Patient-specific factors (e.g., hair texture, race), staff availability, chair time, and equipment limitations all impact SCT implementation. Portable SCT systems and cooling stations outside the infusion chair have been proposed to improve workflow. Limited data suggest shorter post-cooling may be equally effective and better tolerated.

SCT is an effective intervention for CIA, but wide variation in implementation presents challenges. Standardizing cooling durations based on evidence and patient-centered considerations is essential to improve SCT access, patient satisfaction, and healthcare efficiency. Further research is needed to evaluate shortened protocols, portable systems, and pharmacologic adjuncts that may enhance the feasibility and effectiveness of SCT.