Beyond Hair Retention - Regrowth with Scalp Cooling

Conversation led by Richard Paxman with Dr Jyoti Bajpai at the Scalp Cooling Summit. April 2022.

In the past, a patient’s scalp cooling motivation has always been centered around hair retention. But as patient education increases and clinical research trials expand the parameters of the endpoints, regrowth has proven to be another important benefit of scalp cooling. The follicle protection that scalp cooling offers, which results in clinically proven, faster, healthier regrowth, is particularly relevant for patients who sustain higher levels of hair loss. So, why do clinicians need to be aware of the increased rates of regrowth that happens as a result of scalp cooling? And how can we use this knowledge to support patients as robustly as possible?

"If their hair regrowth rate can be enhanced by the time they complete both phases of chemotherapy, the sooner they are able to go back to their normal lives… it is a very important milestone"

Dr Jyoti Bajpai, MBBS, MD, DM(AIIMS)
  • Scalp cooling has been clinically proven to increase the rate of hair regrowth, even when a patient experiences significant hair loss
  • The opportunity to have faster regrowth enables a patient to return to their ‘normal’ lives as quickly as possible
  • Discussing regrowth is particularly important for patients receiving anthracyclines as it can encourage continuation of scalp cooling

Increased hair regrowth rates with scalp cooling have been predicted based on anecdotal experience for some time, but now there is a range of clinical data to support this. Patients have always been motivated by the prospect of reduced and/or delayed alopecia with scalp cooling, but there was little awareness of the enhanced rates of regrowth until they experienced it first-hand – allowing them to return to normal as quickly as possible after chemotherapy treatment. 

It is also important to note that the benefits of hair retention and regrowth are not mutually exclusive – even patients who see significant hair loss can also see increased rates of regrowth. This is particularly important for those patients who receive regimens such as anthracyclines, where higher rates of retention are more challenging. 

Enhanced regrowth at certain stages of treatment also allows for personalized regimen sequencing, to manage if and when patients’ experience hair loss, as well as when they may see regrowth. It has also been noted that there is evidence to suggest that the sequencing of combination regimens can have an impact on retention rates. It has been proposed that when taxanes are given first, there are noticeably higher rates of hair retention by the end of chemotherapy, as the cytoprotective nature of scalp cooling has helped to preserve their hair follicles ready for the anthracycline rounds. However, even for those patients that receive anthracycline regimens first, the use of scalp cooling has the potential to allow regrowth through the taxane phase, allowing patients to see close to normal rates of hair density before the end of chemotherapy. This highlights the need for more research to understand fully the impact that sequencing will have when it comes to hair retention with scalp cooling.

‘If their hair regrowth rate can be enhanced by the time they complete both phases of chemotherapy, the sooner they are able to go back to their normal lives… it is a very important milestone’ – Dr Jyoti Bajpai

Managing patient’s expectations and effective precision medicine counseling is imperative when it comes to ensuring the continuation of scalp cooling if a patient has experienced poor hair retention. This support can be exercised in three stages: 

Firstly the physician can introduce scalp cooling and moderate expectations around retention rates based on regimen, and introduce the concept of faster regrowth

Secondly, nursing teams who have greater contact with the patient during their chemotherapy regimens can continue the regrowth dialogue, manage their expectations accordingly, and address concerns

Thirdly, peer to peer support opportunities are vital in providing additional support and encouragement, as patients who are ahead in the process can share their experiences with those beginning treatment

There is no doubt for those who provide scalp cooling that the treatment has a positive impact on a patient’s experience of chemotherapy and quality of life. By ensuring that clinicians are taking in to account the increased rates of regrowth that scalp cooling can provide, it is possible to provide another tool for carefully managing expectations and helping to encourage continuation of scalp cooling.

Bajpai J, et al. “Randomised controlled trial of scalp cooling for the prevention of chemotherapy induced alopecia”. Breast. 2020 Feb;49:187-193.

Ohsumi S, et al. Prospective study of hair recovery after (neo)adjuvant chemotherapy with scalp cooling in Japanese breast cancer patients. Support Care Cancer. 2021 Oct;29(10):6119-6125.

Episode 2 – Changing the Face of Cancer Podcast. Why we need to be taking about hair regrowth, not just hair retention. With Dr Bajpai and Professor Toi.

Rice BA, et al. Registry study to assess hair loss prevention with the Penguin Cold Cap in breast cancer patients receiving chemotherapy. Breast Cancer Res Treat. 2018 Jan;167(1):117-122.