1. DiGiulio, Sarah

Article Content

Scalp cooling treatment can help prevent one of the many unpleasant side effects of chemotherapy treatment: hair loss.

Crystal Aguh, MD. Cr... - Click to enlarge in new windowCrystal Aguh, MD. Crystal Aguh, MD

"We know that hair loss has a major impact on quality of life," said Crystal Aguh, MD, Assistant Professor of Dermatology and Director of the Ethnic Skin Program at Johns Hopkins School of Medicine. "Chemotherapy-induced hair loss is often considered the most distressing side effect of chemotherapy treatments, having devastating impacts on quality of life with nearly 10 percent of patients declining chemotherapy altogether."


But scalp cooling treatment isn't effective for everyone. Aguh recently coauthored a correspondence that was published online in the Journal of Clinical Oncology about why scalp cooling treatment has different results for women with different hair types (2020; doi: 10.1200/JCO.20.02130). The article explains that women with black curly or kinky hair may require further considerations in the instructions for preparing hair before scalp cooling treatment. And the difference in thickness and structure of their hair may bear on the effectiveness of the scalp cooling treatment.


"Although straight hair and curly hair have identical chemical properties, the difference in physical properties such as shape, texture, and density may necessitate further considerations in the instructions for preparing hair before using scalp cooling devices," the article notes.


In an email interview, Aguh explained the predicament of one of her patients prior to scalp cooling treatment. For that patient, the current guidelines and instructions were not applicable for her type of hair.


"She was concerned that the instructions to wet her hair for improved conduction would cause it to become very curly and bulky-and prevent the cooling cap from fitting tightly. Additionally, the detangling hairbrush provided in the kit historically has led to hair breakage and she was anxious about using it, but wanted to maximize her likelihood of success," noted Aguh.


She had a discussion with the patient about different hair styling options-like braiding or chemically straightening it-to maximize effectiveness of the scalp cooling treatment. But evidence to guide that conversation was very limited.


"There was virtually nothing in the literature that could help guide our recommendations," Aguh said. Here's what she said about the problem and the research that needs to be done.


1 Why and how might the effectiveness of scalp cooling treatment be affected by someone's hair type, texture, and usual care routine?

"To ensure that the scalp is cooled to the requisite goal temperature, proper cap fitting is critical. Although differences in hair texture and shape among different ethnic groups may appear trivial, the effectiveness of scalp cooling is affected by factors determined by the hair type.


"Computer modeling of scalp cooling has correlated hair thickness with decreased effectiveness of scalp cooling. This is a troublesome characteristic for Black women, whose naturally curly hair increases fullness and makes cap wearing difficult. Unfortunately, the majority of data assessing efficacy of scalp cooling therapy reflects its use on white patients."


2 So what do you think should be done to address this problem and make sure that effectiveness of scalp cooling treatment is effective for everyone?

"Limited data has suggested that scalp cooling is less-effective in people of African descent for unknown reasons. Research is needed to see if differing hairstyles are more or less likely to lead to treatment success in Black women. What we offer in the article are some hairstyling suggestions for Black women that can be used until better data is available.


"But studies are needed that directly address this question of efficacy in Black patients compared to women of other racial/ethnic groups undergoing scalp cooling or the impact on different hair styling practices on results."


3 What's the takeaway message that practicing oncologists and cancer care providers-as well as other researchers-should know about this problem?

"Reducing barriers for successful scalp cooling treatment in Black women has the potential to increase the number of women choosing to undergo lifesaving chemotherapeutic treatment. This underscores the need for a greater understanding of hair types and styling practices among different racial groups.


"It's clear we need better physician understanding of the unique properties of Black kinky/curly hair, its properties, and styling differences [compared with] straight hair. Though straight hair and curly hair have identical chemical properties, the difference in physical properties such as shape, texture, and density may necessitate further considerations in preparation instructions for the use of scalp cooling devices."