Supportive Care in Cancer

, Volume 21, Issue 9, pp 2565–2573 | Cite as

Efficacy and tolerability of two scalp cooling systems for the prevention of alopecia associated with docetaxel treatment

  • Daniel C. BetticherEmail author
  • Geoffrey Delmore
  • Urs Breitenstein
  • Sandro Anchisi
  • Beatrice Zimmerli-Schwab
  • Andreas Müller
  • Roger von Moos
  • Anne Marguerite Hügli-Dayer
  • Hubert Schefer
  • Sereina Bodenmann
  • Vera Bühler
  • Ralph R. Trueb
Original Article



Chemotherapy-induced alopecia is very distressing for a patient and may have an impact on treatment decisions. On docetaxel-based therapy, alopecia occurs in a substantial proportion of patients. We aimed to investigate whether two different methods of scalp cooling can prevent hair loss.


In this open-label, prospective, nonrandomized trial, patients with solid tumors receiving docetaxel in a palliative setting were allocated according to patients’ preference to short-term cooling (over 45 min postinfusion) with a Paxman® PSC-2 machine (PAX), with cold cap (CC), or no cooling. The combined endpoint was alopecia World Health Organisation (WHO) III or IV or the necessity to wear a wig. Study identifier is NCT01008774.


Two hundred thirty-eight patients were included in the trial (128 patients PAX, 71 CC, and 39 no cooling). Number of cycles (median 4) and median docetaxel doses were similar across groups (55–60 mg/day on weekly therapy, 135–140 mg/day on 3-weekly therapy). Alopecia occurred with PAX, CC, and no cooling under 3-weekly docetaxel in 23, 27, and 74 % and under weekly docetaxel in 7, 8, and 17 %, respectively. Overall, cooling (PAX and CC combined) reduced risk of alopecia by 78 % (hazard ratio 0.22; 95 % confidence interval 0.12 to 0.41). CC and PAX prophylaxis led to the same degree of prevention of alopecia. Adverse events (AE) were reported in 5 % (most frequently, sensation of cold), and 30 patients (13 %) discontinued cooling measures after cycle 1.


In this first comparison published to date, both PAX and CC offer efficacious protection against hair loss, in particular when docetaxel is administered in a 3-weekly interval.


Alopecia Hair loss Scalp cooling Supportive care Patient-reported outcomes Comparison 



Christian Schmidhauser, Ph.D., (la volta statistics, Zurich, Switzerland) performed the statistical analyses. David Pittrow, MD, advised on contents of the manuscript and interpretation of data.

We appreciate the support of Frank Verholen, MD (Sanofi-Aventis (Suisse) SA) and Danièle Brack (Sanofi-Aventis (Suisse) SA) as well as the contribution of the investigators of the participating centers in Switzerland (listed in alphabetical order):

Prof. Dr. med. Markus Borner

Chefarzt, Medizinische Onkologie,Spitalzentrum, Im Vogelsang 84, 2502 Biel/Bienne, Switzerland


Tel.: +41-32-3242424

Dott. med. Antonello Calderoni

FMH Oncologia Medica, Via Fogazzaro 3, 6900 Lugano, Switzerland


Tel.: +41-91-9226988

Dr. med. Clemens Caspar

Chefarzt Onkologie, Medizinische Klinik, Kantonsspital Baden AG, 5404 Baden, Switzerland


Tel.: +41-56-4862111

Dr. med. Corinne Cescato-Wenger

Oberärztin, Medizinische Abteilung, St. Claraspital, Kleinriehenstrasse 30, 4058 Basel, Switzerland


Tel.: +41-61-6858585

Dr. Petr Cech

FMH Oncologie Médicale, Route de Villars 37, 1700 Fribourg, Switzerland


Tel.: +41-26-3474305

Dr. med. Manuel Jeschko

FMH Medizinische Onkologie, Onkologie Länggasse, Fabrikstrasse 24b, 3012 Bern, Switzerland


Tel.: +41-31-3005090

Dr. Claudius Irlé

FMH Oncologie Médicale, Avenue J.-D.-Maillard 11, 1217 Meyrin, Switzerland


Tel.: +41-22-7830500/+41-62-8367830

Dr. med. Martin F. Hagen

FMH Medizinische Onkologie, Seestrasse 80, 8810 Horgen, Switzerland


Tel.: +41-44-7277727

Dr. Volker Kirchner

FMH Oncologie Médicale, Clinique de Genolier, Route du Muids 3, 1272 Genolier, Switzerland


Tel.: +41-22-3669000

Dr. med. Meinrad Mannhart-Harms

FMH Medizinische Onkologie, OHZ Zug, Andreas Klinik, Rigistrasse 1, 6330 Cham, Switzerland


Tel.: +41-41-7840884

Dr. med. Razvan Andrei Popescu

FMH Medizinische Onkologie, Tumor Zentrum, Hirslanden Medical Center, Rain 34, 5000 Aarau, Switzerland


Tel.: +41-62-8367830

Dr. med. Martin Wernli

Chefarzt, Onkologie, Kantonsspital, Tellstrasse, 5001 Aarau, Switzerland


Tel.: +41-62-8384141

Dr. med. Lucas Andreas Widmer

FMH Medizinische Onkologie, Onkozentrum Hirslanden, Klinik Hirslanden, Postfach, 8032 Zürich, Switzerland


Tel.: +41-44-3873780

Dr. med. Ralph Winterhalder

Leitender Arzt, Medizinische Klinik, Luzerner Kantonsspital, Spitalstrasse, 6004 Luzern, Switzerland


Tel.: +41-41-2051111

Dr. med. Reinhard Zenhäusern

Onkologie, Spitalzentrum Oberwallis, Überlandstrasse 14, 3900 Brig, Switzerland


Tel.: +41-27-9703333

Conflict of interest

Sanofi-Aventis Suisse funded this study. Sereina Bodenmann and Vera Bühler are full-time employees of Sanofi-Aventis Suisse. The rest of the authors declare no conflict of interest related to this study. The authors had full control of all primary data. The authors agree to allow the journal to review their data if requested.


  1. 1.
    Trueb RM (2010) Chemotherapy-induced alopecia. Curr Opin Support Palliat Care 4(4):281–284CrossRefGoogle Scholar
  2. 2.
    Breed W, van den Hurk CJG, Peerbooms M (2011) Presentation, impact and prevention of chemotherapy-induced hair loss. Expert Rev Dermatol 6(1):109–125CrossRefGoogle Scholar
  3. 3.
    Lemieux J, Maunsell E, Provencher L (2008) Chemotherapy-induced alopecia and effects on quality of life among women with breast cancer: a literature review. Psychooncology 17(4):317–328CrossRefGoogle Scholar
  4. 4.
    Hesketh PJ, Batchelor D, Golant M, Lyman GH, Rhodes N, Yardley D (2004) Chemotherapy-induced alopecia: psychosocial impact and therapeutic approaches. Support Care Cancer 12(8):543–549PubMedGoogle Scholar
  5. 5.
    Pesce A, Cassuto JP, Joyner MV, DuJardin P, Audoly P (1978) Scalp tourniquet in the prevention of chemotherapy-induced alopecia. N Engl J Med 298(21):1204–1205PubMedGoogle Scholar
  6. 6.
    Duvic M, Lemak NA, Valero V, Hymes SR, Farmer KL, Hortobagyi GN, Trancik RJ, Bandstra BA, Compton LD (1996) A randomized trial of minoxidil in chemotherapy-induced alopecia. J Am Acad Dermatol 35(1):74–78CrossRefGoogle Scholar
  7. 7.
    Davis ST, Benson BG, Bramson HN, Chapman DE, Dickerson SH, Dold KM, Eberwein DJ, Edelstein M, Frye SV, Gampe RT Jr, Griffin RJ, Harris PA, Hassell AM, Holmes WD, Hunter RN, Knick VB, Lackey K, Lovejoy B, Luzzio MJ, Murray D, Parker P, Rocque WJ, Shewchuk L, Veal JM, Walker DH, Kuyper LF (2001) Prevention of chemotherapy-induced alopecia in rats by CDK inhibitors. Science 291(5501):134–137CrossRefGoogle Scholar
  8. 8.
    Breed WP (2004) What is wrong with the 30-year-old practice of scalp cooling for the prevention of chemotherapy-induced hair loss? Support Care Cancer 12(1):3–5CrossRefGoogle Scholar
  9. 9.
    Grevelman EG, Breed WP (2005) Prevention of chemotherapy-induced hair loss by scalp cooling. Ann Oncol 16(3):352–358CrossRefGoogle Scholar
  10. 10.
    Paxman Coolers Ltd. Paxman PSC-2 broschure. Internet: Accessed on 9 September 2012
  11. 11.
    Bulow J, Friberg L, Gaardsting O, Hansen M (1985) Frontal subcutaneous blood flow, and epi- and subcutaneous temperatures during scalp cooling in normal man. Scand J Clin Lab Invest 45(6):505–508CrossRefGoogle Scholar
  12. 12.
    Ridderheim M, Bjurberg M, Gustavsson A (2003) Scalp hypothermia to prevent chemotherapy-induced alopecia is effective and safe: a pilot study of a new digitized scalp-cooling system used in 74 patients. Support Care Cancer 11(6):371–377PubMedGoogle Scholar
  13. 13.
    Macduff C, Mackenzie T, Hutcheon A, Melville L, Archibald H (2003) The effectiveness of scalp cooling in preventing alopecia for patients receiving epirubicin and docetaxel. Eur J Cancer Care 12(2):154–161CrossRefGoogle Scholar
  14. 14.
    Oken MM, Creech RH, Tormey DC, Horton J, Davis TE, McFadden ET, Carbone PP (1982) Toxicity and response criteria of the Eastern Cooperative Oncology Group. Am J Clin Oncol 5(6):649–655CrossRefGoogle Scholar
  15. 15.
    World Health Organisation Handbook for reporting results of cancer treatment. WHO Offset Publications, Geneva, 1979. Internet: Accessed on 10 January 2013
  16. 16.
    van den Hurk C, Breed W, Nortier J (2009) Short post-infusion cooling time of scalp cooling in the prevention of docetaxel-induced hair loss.Poster presentation at the Annual Meeting of the European Cancer Organisation (ECCO), 20–24 September 2009, Berlin, GermanyGoogle Scholar
  17. 17.
    Ottevanger PB, Therasse P, van de Velde C, Bernier J, van Krieken H, Grol R, De Mulder P (2003) Quality assurance in clinical trials. Crit Rev Oncol Hematol 47(3):213–235CrossRefGoogle Scholar
  18. 18.
    Edelstyn GA, MacDonald M, MacRae KD (1977) Doxorubicin-induced hair loss and possible modification by scalp cooling. Lancet 2(8031):253–254CrossRefGoogle Scholar
  19. 19.
    Giaccone G, Di Giulio F, Morandini MP, Calciati A (1988) Scalp hypothermia in the prevention of doxorubicin-induced hair loss. Cancer Nurs 11(3):170–173PubMedGoogle Scholar
  20. 20.
    Parker R (1987) The effectiveness of scalp hypothermia in preventing cyclophosphamide-induced alopecia. Oncol Nurs Forum 14(6):49–53PubMedGoogle Scholar
  21. 21.
    Ron IG, Kalmus Y, Kalmus Z, Inbar M, Chaitchik S (1997) Scalp cooling in the prevention of alopecia in patients receiving depilating chemotherapy. Support Care Cancer 5(2):136–138CrossRefGoogle Scholar
  22. 22.
    Satterwhite B, Zimm S (1984) The use of scalp hypothermia in the prevention of doxorubicin-induced hair loss. Cancer 54(1):34–37CrossRefGoogle Scholar
  23. 23.
    Auvinen PK, Mahonen UA, Soininen KM, Paananen PK, Ranta-Koponen PH, Saavalainen IE, Johansson RT (2010) The effectiveness of a scalp cooling cap in preventing chemotherapy-induced alopecia. Tumori 96(2):271–275CrossRefGoogle Scholar
  24. 24.
    van den Hurk CJ, Breed WP, Nortier JW (2012) Short post-infusion scalp cooling time in the prevention of docetaxel-induced alopecia. Support Care Cancer 20(12):3255–3260CrossRefGoogle Scholar
  25. 25.
    van den Hurk C Synoptic report in: Paxman clinical report summary of scalp cooling efficacy, page 10. Version 04–11. Internet: Accessed on 9. September 2012
  26. 26.
    Massey CS (2004) A multicentre study to determine the efficacy and patient acceptability of the Paxman Scalp Cooler to prevent hair loss in patients receiving chemotherapy. Eur J Oncol Nurs 8(2):121–130CrossRefGoogle Scholar
  27. 27.
    van den Hurk CJ, Peerbooms M, van de Poll-Franse LV, Nortier JW, Coebergh JW, Breed WP (2012) Scalp cooling for hair preservation and associated characteristics in 1411 chemotherapy patients—results of the Dutch Scalp Cooling Registry. Acta Oncol 51(4):497–504CrossRefGoogle Scholar
  28. 28.
    Delgado-Rodriguez M, Llorca J (2004) Bias. J Epidemiol Community Health 58(8):635–641CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Daniel C. Betticher
    • 1
    Email author
  • Geoffrey Delmore
    • 2
  • Urs Breitenstein
    • 3
  • Sandro Anchisi
    • 4
  • Beatrice Zimmerli-Schwab
    • 5
  • Andreas Müller
    • 6
  • Roger von Moos
    • 7
  • Anne Marguerite Hügli-Dayer
    • 8
  • Hubert Schefer
    • 9
  • Sereina Bodenmann
    • 10
  • Vera Bühler
    • 10
  • Ralph R. Trueb
    • 11
  1. 1.Clinics of Medical OncologyHFR Fribourg Cantonal HospitalFribourgSwitzerland
  2. 2.Medizinische OnkologieKantonsspital FrauenfeldFrauenfeldSwitzerland
  3. 3.Onkozentrum ZürichZürichSwitzerland
  4. 4.Departement d’oncologieHôpital de SionSionSwitzerland
  5. 5.Service d’OncologieHôpital PourtalèsNeuchâtelSwitzerland
  6. 6.Medizinische OnkologieKantonsspitalWinterthurSwitzerland
  7. 7.Medizinische OnkologieKantonsspital GraubündenChurSwitzerland
  8. 8.Onkologische PraxisGenèveSwitzerland
  9. 9.OnkoZentrum Luzern, Hirslanden Klinik St. AnnaLuzernSwitzerland
  10. 10.Sanofi-Aventis (Suisse) SAVernierSwitzerland
  11. 11.Dermatologische Praxis und HaarcenterWallisellenSwitzerland

Personalised recommendations