Hair loss with chemotherapy: at a loss over its management?

Ethical, legal, organizational and social issues related to the use of scalp cooling for the prevention of chemotherapy-induced alopecia: A systematic review

INTRODUCTION

Scalp cooling (SC) aims to prevent chemotherapy-induced alopecia. The goal of this systematic review is to tackle ethical, legal, organizational and social issues related to SC.

METHODS

A critical appraisal of the literature was carried out using a systematic review design. MEDLINE, Embase and Web of Science databases were searched up until 2 June 2021. Studies addressing these aspects in English or Spanish were considered. Representatives of both patient associations and professional scientific societies related to the topic participated in the design of the protocol and the review of the findings.

RESULTS

A total of 17 studies were included. Articles were critically appraised using the MMAT and SANRA. Findings were organized into four categories: (1) ethical aspects focused on equal access, gender equity and doctor-patient communication supported by Patient Decision Aids (PtDAs); (2) patient perspective and acceptability; (3) professional perspective and acceptability; (4) organizational aspects focused on accessibility and feasibility.

CONCLUSION

Cancer patients' expectations when using SC need to be adjusted to reduce the potential distress associated with hair loss. PtDAs could help patients clarify their values and preferences regarding SC. Equal access to technology should be guaranteed.

PATIENT OR PUBLIC CONTRIBUTION

In this systematic review, the representatives of the patient associations (Ms. María Luz Amador Muñoz of the Spanish Association Against Cancer [AECC] and Ms. Catiana Martinez Cánovas of the Spanish Breast Cancer Federation [FECMA]) participated in the review of the study protocol, as well as in the results, discussion and conclusions, making their contributions. In the type of design of these studies (systematic reviews), it is not usual to have the direct participation of patients, but in this one, we have done so, as it is a systematic review that is part of a report of the Spanish Network of Health Technology Assessment Agencies (ETS).

The Effectiveness of a Scalp Cooling Cap in Preventing Chemotherapy-Induced Alopecia

Aims and background

Hair loss is one of the most unpleasant side effects associated with chemotherapy treatments. It causes emotional disturbances and constantly reminds the patient of the disease. This study analyzed the effectiveness of scalp cooling caps in preventing alopecia among 64 patients.

Methods

The patients were given one of the following chemotherapeutic treatments: doxorubicin 60 mg/m2, docetaxel 80 mg/m2, FEC (5-fluorouracil 600 mg/m2, epirubicin 60 mg/m2, cyclophosphamide 600 mg/m2) or the combination of three cycles of docetaxel (80 mg/m2) followed by three cycles of FEC (5-fluorouracil 600 mg/m2, epirubicin 60 mg/m2, cyclophosphamide 600 mg/m2). All the chemotherapy treatments were given in a three-weekly schedule. Patients with early stage disease were given six adjuvant chemotherapy cycles, while patients with metastatic disease were given nine chemotherapy cycles. The patients were provided with detailed instructions on how to treat the hair at home for one to three days after the chemotherapy treatment. Hair loss was evaluated after the third, sixth and final treatments.

Results

In the final results, major hair loss was avoided in all patients given doxorubicin treatment, in 83.3% of patients given docetaxel treatment, in 76.5% of patients given FEC treatment, and in 78% of patients given docetaxel followed by FEC. In the final evaluation, 87.5% of the patients considered the avoidance of hair loss to be important. Only 20.3% of the patients needed to use a wig.

Conclusions

This study shows that all the patient groups studied gained some benefit by using scalp cooling caps.

Identification of oxidized protein hydrolase as a potential prodrug target in prostate cancer

Background

Esterases are often overexpressed in cancer cells and can have chiral specificities different from that of the corresponding normal tissues. For this reason, ester prodrugs could be a promising approach in chemotherapy. In this study, we focused on the identification and characterization of differentially expressed esterases between non-tumorigenic and tumorigenic prostate epithelial cells.

Methods

Cellular lysates from LNCaP, DU 145, and PC3 prostate cancer cell lines, tumorigenic RWPE-2 prostate epithelial cells, and non-tumorigenic RWPE-1 prostate epithelial cells were separated by native polyacrylamide gel electrophoresis (n-PAGE) and the esterase activity bands visualized using α-naphthyl acetate or α-naphthyl-N-acetylalaninate (ANAA) chiral esters and Fast Blue RR salt. The esterases were identified using nanospray LC/MS-MS tandem mass spectrometry and confirmed by Western blotting, native electroblotting, inhibition assays, and activity towards a known specific substrate. The serine protease/esterase oxidized protein hydrolase (OPH) was overexpressed in COS-7 cells to verify our results.

Results

The major esterase observed with the ANAA substrates within the n-PAGE activity bands was identified as OPH. OPH (EC 3.4.19.1) is a serine protease/esterase and a member of the prolyl oligopeptidase family. We found that LNCaP lysates contained approximately 40% more OPH compared to RWPE-1 lysates. RWPE-2, DU145 and PC3 cell lysates had similar levels of OPH activity. OPH within all of the cell lysates tested had a chiral preference for the S-isomer of ANAA. LNCaP cells were stained more intensely with ANAA substrates than RWPE-1 cells and COS-7 cells overexpressing OPH were found to have a higher activity towards the ANAA and AcApNA than parent COS-7 cells.

Conclusions

These data suggest that prodrug derivatives of ANAA and AcApNA could have potential as chemotherapeutic agents for the treatment of prostate cancer tumors that overexpress OPH.

A comparison of men and women's experiences of chemotherapy-induced alopecia

PURPOSE

The effect of alopecia on men and women has not been fully documented in the literature, especially for Turkish cancer patients. The aim of this study was to determine the incidence of chemotherapy-related alopecia and how it affects the body image and quality of life of Turkish male and female cancer patients, in order to identify variables that may be important in the perception of this problem.

METHODS

This descriptive study was carried out between November 2010 and June 2011 at Istanbul University Institute of Oncology; 201 men and 204 women attended. A face-to-face interview was performed during chemotherapy, and the effects of alopecia on cancer patients were assessed using the Patient Information Form, Body Image Scale, and Nightingale Symptom Assessment Scale.

RESULTS

The study group consisted of 55.1% female and 44.9% male patients. Most of the patients experienced partial or total alopecia during chemotherapy. There were no differences between men and women with regard to body image in respect of degree of alopecia, but the body image of the male and female patients who had partial or complete alopecia was lower than that in patients who had no alopecia; psychological well-being of women was lower than that in men, because the incidence of alopecia was higher in women.

CONCLUSIONS

This study contributes new knowledge on the cultural characteristics of Turkish patients, which may assist other researchers working with different international populations. Alopecia is a difficult side effect for both men and women. Health professionals should assess and educate patients differently from the current standard.

Chemotherapy-induced alopecia: advice and support for hair loss

This article provides insight into the growth cycle of a hair follicle and the potential impact chemotherapy agents can have on this process, which often results in hair loss (alopecia). It explores the psychological consequences of chemotherapy-induced alopecia for an individual as a result of the perceptions of others as well as an individual's perception of his or her self-image. Despite the development of various forms of scalp cooling, chemotherapy-induced alopecia remains a major side effect for patients receiving chemotherapy; however, there have been improvements in wig provision and changing public opinion relating to baldness. Although chemotherapy-induced alopecia affects both males and females and all age groups, this article focuses on the potential impact for patients receiving chemotherapy as a form of treatment for breast cancer. As professionals we need to understand the social significance of hair in relation to a person's outward presentation and social interactions, along with the possible psychological implications of a person losing his or her bodily hair, and not just the head hair. We must aim to minimize the distress alopecia can cause by: ensuring we provide patients with up-to-date verbal and written information to enable them to prepare for losing their hair; helping them to preserve their self-image and minimize the psychological consequences of hair loss while receiving chemotherapy; and preparing them for their hair re-growth following completion of chemotherapy.

Women's Experiences of an Altered Appearance during Chemotherapy

This study explores breast cancer patients' experiences of chemotherapy treatment, with a focus on the impact of an altered appearance during this time. We present two key themes from the thematic analysis of interviews with 19 women: anxiety that chemotherapy will render them identifiable as a `person-with-cancer'; and problematic interactions with others. We discuss how changes in appearance can reveal disease status to others, demonstrate the personal impact of temporary changes to appearance, relate these findings to literature on psychosocial aspects of disfigurement and consider the provision of psychosocial care for women experiencing an altered appearance during chemotherapy.

Have men been overlooked? A comparison of young men and women's experiences of chemotherapy-induced alopecia

OBJECTIVE

The objective of this study is to compare men and women's accounts of chemotherapy-induced alopecia.

DESIGN

Secondary analysis of narrative interview data.

PARTICIPANTS

Thirty-seven people aged 18-38 years, including 11 men and 8 women who had experienced hair loss, interviewed between 2000 and 2005.

SETTING

Participants were recruited throughout the United Kingdom.

RESULTS

Hair loss made many men and women acutely aware of their vulnerability and visibility as a 'cancer patient'. Both men and women described a sense of strangeness or shock when they lost their hair and experienced various negative reactions when people assumed their hairless appearance was a lifestyle choice. The most striking contrast in men's and women's accounts was that women spoke solely of the loss of hair from the head and face above the eye line, and men spoke about losing hair from wider body surfaces. Only women mentioned being encouraged by others to disguise or to prevent hair loss. The results are discussed in relation to gendered assumptions about the distribution of body hair.

CONCLUSIONS

Contrary to prevailing assumptions, both women and men described negative (and often similar) feelings about hair loss. Understanding these experiences can help professionals better equip their patients to deal with this aspect of their treatment.