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.

PurposeThis study investigated adherence to treatment guidelines on cancer-related anaemia and fatigue (CRA/CRF) and factors influencing the choice of intervention.MethodsIn this prospective, observational study, 136 cancer patients being treated with chemotherapy in a large community hospital completed a questionnaire at consecutive outpatient visits assessing fatigue (the Functional Assessment of Chronic Illness Therapy—Fatigue) and fatigue-related counselling and advice received. Data on administration of chemotherapy and use of epoetin or blood transfusions were abstracted from the medical records.ResultsFifty-three percent of patients with severe anaemia (Hb < 10 g/dl) and 6% of patients with less severe anaemia (Hb levels 10–12 g/dl) received treatment (epoetin and/or blood transfusions). Half of the patients with less severe anaemia reported clinically relevant levels of fatigue. More than 50% of all patients received fatigue-related counselling, primarily at the start of chemotherapy. Most counselling was directed at energy conservation. Fatigue was not associated significantly with the use of epoetin or blood transfusion. Patients receiving palliative treatment (17%), male patients (16%) and patients with a low Hb level (<6.2 g/dl, 38%) were treated significantly more often with epoetin.ConclusionsIn daily clinical practice, guidelines concerning the use of epoetin or blood transfusion in severe CRA are adhered to in about half of the cases. In patients with less severe anaemia, the level of fatigue did not play a significant role in the use of epoetin. According to current guidelines, counselling on CRF should be directed primarily at activity enhancement. However, only a minority of patients receive such counselling.

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A highly distressing side-effect of cancer chemotherapy is chemotherapy-induced alopecia (CIA). Scalp cooling remains the only treatment for CIA, yet there is no experimental evidence to support the cytoprotective capacity of cooling. We have established a series of in vitro models for the culture of human keratinocytes under conditions where they adopt a basal, highly-proliferative phenotype thus resembling the rapidly-dividing sub-population of native hair-matrix keratinocytes. Using a panel of chemotherapy drugs routinely used clinically (docetaxel, doxorubicin and the active metabolite of cyclophosphamide 4-OH-CP), we demonstrate that although these drugs are highlycytotoxic, cooling can markedly reduce or completely inhibit drug cytotoxicity, in agreement with clinical observations. By contrast, we show that cytotoxicity caused by specific combinatorial drug treatments cannot be adequately attenuated by cooling, supporting data showing that such treatments do not always respond well to cooling clinically. Importantly, we provide evidence that the choice of temperature may be critical in determining the efficacy of cooling in rescuing cells from drug-mediated toxicity. Therefore, despite their reductive nature, these in vitro models have provided experimental evidence for the clinically-reported cytoprotective role of cooling and represent useful tools for future studies on the molecular mechanisms of cooling-mediated cytoprotection. Chemotherapy-induced alopecia (CIA) is the most common and distressing side effect of anticancer chemotherapy (Wang et al., 2006) and the anxiety caused by the prospect of CIA can cause patients to even refuse treatment in certain cases (Munstedt et al., 1997). Thus development of an effective CIA preventative regime represents an important challenge in oncology (Paus et al., 2013). CIA occurs due to damage to the hair follicles, which comprise various cell types including hair matrix keratinocytes, which represent the most rapidly dividing cell subset and contribute to follicular structure and function (Roh et al., 2005). As chemotherapeutic drugs such as taxanes (e.g. docetaxel), alkylating agents (e.g. cyclophosphamide) and anthracyclines/DNA intercalating agents (e.g. doxorubicin) target cancer cells due to their rapid division rate, these drugs also target the matrix keratinocytes which results in hair loss (Paus et al., 2013). AbbreviationsCurrently the only available preventative treatment for CIA is head (scalp) cooling. Scalp cooling or hypothermia during the administration of chemotherapy drugs can substantially reduce hair loss (Protiere et al., 2002) and has been used since the 1970s (Dean et al., 1979). Clinically it has been shown that scalp cooling can substantially reduce the incidence of hair loss in response to individual drugs, including cyclophosphamide, doxorubicin and cisplatin (Breed et al., 2011;van den Hurk et al., 2012). However, for combined treatment regimens, such as sequential treatment with docetaxel (taxotere), doxorubicin (adriamycin) an...

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