Management of Chemotherapy-Induced Alopecia: A Systematic Review and Meta-Analysis

Abstract

Introduction: Chemotherapy‑induced alopecia (CIA) is a common and distressing side effect that can lead to treatment refusal or discontinuation.

Objectives: This systematic review and meta‑analysis evaluated the effectiveness, safety, and patient‑reported outcomes of interventions for CIA.

Methodology: Following PRISMA guidelines, we searched PubMed, EBSCO, Medline, Google Scholar, Wiley, and Web of Science for relevant randomized and quasi‑experimental trials.

Results: Thirteen studies comprising over 1,200 patients were included. Scalp cooling reduced moderate‑to‑severe CIA by more than half. Acceptable hair preservation rates ranged from 75–95% with cooling versus 8–49% in controls. In a meta‑analysis of three trials, cooling increased the odds of maintaining cosmetically acceptable hair over fourteen‑fold (OR 14.42; 95% CI 2.79–74.63; P = 0.001; I² = 62%). A separate meta‑analysis of four trials (N = 262) showed a 90% reduction in the odds of moderate‑to‑severe alopecia (OR 0.10; 95% CI 0.02–0.54; P = 0.007; I² = 70%). Patient‑reported need for wigs fell from 45–84% in controls to 5–33% with cooling. Adverse events were mild (headaches in up to 25%, chills, cold sensation) and led to discontinuation in fewer than 30% of cooled patients.

Conclusion: Scalp cooling is a safe, well‑tolerated intervention that substantially mitigates hair loss, achieves high patient satisfaction, and reduces the psychosocial burden of CIA. It should be considered standard supportive care for patients receiving hair‑toxic chemotherapy.