Efficacy of Scalp Cooling in Mitigating Chemotherapy-induced Alopecia in Women with Early Breast Cancer: A Systematic Review

Written by Lorelei Fen, Michelle Pomales, & Dula F. Pacquiao

doi: https://doi.org/10.13178/jnparr.2026.1601.1603

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Abstract
Background: Chemotherapy-induced alopecia (CIA) is a common side effect of various chemotherapy agents. Approximately 80% of patients regard CIA as one of the most

distressing and feared side effects of chemotherapy with 8%-14% of patients refusing potentially lifesaving cancer treatment or opt for less effective drugs.

Objective: To evaluate the efficacy of scalp cooling (SC) in mitigating CIA in earlybreast cancer patients compared to no intervention.

Methods: A systematic review was conducted following the PRISMA guidelines using Cochrane, CINAHL, and Medline databases. Selected studies comprised full-text publications in peer-reviewed journals between 2015-2025, involving adult women with early breast cancer undergoing chemotherapy and treated with any SC devices. Six studies included comprised systematic reviews with meta-analysis, randomized controlled trials, and prospective cohort studies. Studies that combined SC with other interventions were excluded.

Results: SC is well tolerated and effective in reducing CIA in 43%-81% of patientsreceiving chemotherapy. Higher efficacy observed in patients treated with taxane-based chemotherapy particularly paclitaxel monotherapy compared with anthracycline containing regimens. No significant differences observed between automated and non-automated systems. Adverse effects were mild and patients reported improved hair preservation and satisfaction.

Conclusion: SC reduces risk of significant CIA and physical and emotional distress of breast cancer patients undergoing chemotherapy. Consistent efficacy of SC across different regimens and devices supports its clinical use to promote quality of life and chemotherapy adherence. Further studies are needed to develop consistent protocols and improve affordability and accessibility.

Keywords: scalp cooling, cold caps, prevention of chemotherapy-induced alopecia,breast cancer