Systematic review and meta-analysis of adverse effects of scalp cooling for the reduction of chemotherapy-induced alopecia

Chemotherapy-induced alopecia (CIA) affects approximately 65% of patients receiving chemotherapy and has a negative impact on quality of life. A systematic review and meta-analysis evaluated adverse effects (AEs) of scalp cooling (SC) for CIA. Sixty-seven studies met the inclusion criteria. The most common AEs were generalized chills (42%; 95% CI 26-58), cap heaviness (35%; 18-52), and headache (30%; 21-39). SC discontinuation rate was 18% (95% CI 13-23). The most common reasons for discontinuation were progressive alopecia (15%; 95% CI 10-20) and reasons unrelated to SC (9%; 5-13). The most frequent AEs leading to SC discontinuation were headache (4%; 95% CI 2-6), cold intolerance (4%; 3-5), and general discomfort (4%; 2-7). Secondary analysis of scalp metastases yielded an incidence of 0.15% (95% CI 0.05-0.47). The authors conclude that SC is generally well tolerated with minimal safety concerns.