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With increasing survival rates across all cancers, survivors represent a growing population that is frequently affected by persistent or permanent hair growth disorders as a result of systemic therapies, radiotherapy, surgical procedures, and therapeutic transplants. These hair disorders include persistent chemotherapy-induced alopecia, persistent radiotherapy-induced alopecia, endocrine therapy-induced alopecia and hirsutism, post-surgery alopecia and localized hypertrichosis, alopecia attributed to therapeutic transplants, and to novel anticancer therapies. The information contained in this continuing medical education article should facilitate a better understanding on hair disorders in cancer survivors, so that adequate support and therapies may be provided to cancer survivors.
Introduction. The success of scalp cooling in preventing or reducing chemotherapy-induced alopecia (CIA) is highly variable between patients and chemotherapy regimens. The outcome of hair preservation is often unpredictable and depends on various factors. Methods. We performed a structured search of literature published from 1970 to February 2012 for articles that reported on factors influencing the effectiveness of scalp cooling to prevent CIA in patients with cancer. Results. The literature search identified 192 reports, of which 32 studies were considered relevant. Randomized studies on scalp cooling are scarce and there is little information on the determinants of the result. The effectiveness of scalp cooling for hair preservation depends on dose and type of chemotherapy, with less favorable results at higher doses. Temperature seems to be an important determinant. Various studies suggest that a subcutaneous scalp temperature less than 22°C is required for hair preservation. Conclusions. The effectiveness of scalp cooling for hair preservation varies by chemotherapy type and dose, and probably by the degree and duration of cooling. The Oncologist 2013;18: 885-891 Implications for Practice: Despite the continuous development of cytotoxics and new targeted therapies, chemotherapyinduced alopecia (CIA) remains a major problem. The ongoing underestimation by medical professionals of the high impact of CIA for patients and their relatives has resolved in minimal efforts to prevent CIA. The literature is mainly restricted to patient series evaluating the effectiveness. Future research should focus on determinants of the result, in particular, scalp cooling temperature and time. Reviews on scalp cooling clearly show that scalp cooling is an effective method to prevent CIA. Scalp cooling should therefore be available in every hospital and health care professionals should offer the possibility of scalp cooling to all eligible patients.
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