Scalp cooling (or scalp hypothermia) reduces chemotherapy-induced alopecia, alleviates psychological distress, and improves quality of life (QoL) in patients with primary gynaecologic cancers receiving carboplatin plus paclitaxel, the single-centre, randomized controlled CHARM trial has shown.
About 17 percent of women with gynaecologic cancers consider alopecia as the most traumatic adverse event (AE), and up to 14 percent might refuse curative therapies that are associated with alopecia. [J Am Acad Dermatol 2018;80:1179-1196]
“Scalp cooling can prevent chemotherapy-induced alopecia in patients with breast cancer. However, data on patients with gynaecologic cancers, especially Asian patients, were scarce,” wrote the researchers from the University of Hong Kong and Queen Mary Hospital (QMH), Hong Kong. They therefore conducted a single-centre, randomized controlled trial in 79 women with gynaecologic cancers in QMH. Patients were randomized 1:1 to receive scalp cooling (n=40; median age, 55 years) or usual clinical care (n=39; median age, 53 years). [Sci Rep 2026;doi:10.1038/s41598-026-44772-2]
“To our knowledge, our study is the first randomized trial on scalp cooling in gynaecologic cancers in the Asian population,” noted the researchers.
Hair preservation with scalp cooling
The primary endpoint was hair preservation at the end of chemotherapy, defined as a Dean score ≤2 (≤50 percent hair loss). Up to 30 percent of patients in the scalp-cooling group preserved their hair, compared with none in the usual clinical care group (p=0.002).
“Our cohort showed lower efficacy [of scalp cooling] than results reported in other studies. This discrepancy may reflect differences in tumour types and chemotherapy regimens,” noted the researchers. “Most prior research focused on breast cancer, whereas the current study focused on gynaecologic cancers in patients receiving carboplatin and paclitaxel.”
Reduced psychological stress, better QoL
“Our study was the largest cohort evaluating the effect of scalp cooling on psychological distress in women receiving 3-weekly carboplatin and paclitaxel,” pointed out the researchers. Psychological distress was measured by the Patient Health Questionnaire Anxiety and Depression Scale (PHQ-ADS).
Scalp cooling was associated with a significantly lower PHQ-ADS score after the second cycle of chemotherapy (median, 5.5 vs 11; p=0.045) vs usual care. Additionally, significantly fewer patients in the scalp-cooling group had mild to severe psychological distress (PHQ-ADS score ≥10; 27.8 vs 62.2 percent; p=0.003) after cycle 2.
Other secondary endpoints included QoL, as assessed by the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire–Core 30.
Overall, the scalp-cooling group demonstrated a better global health status, although the difference was significant only after cycle 4. There were also significant improvements in physical functioning and role functioning in the scalp-cooling vs usual clinical care group as early as after cycle 2.
Notably, social functioning was relatively preserved in the scalp-cooling group, whereas the usual care practice group showed deterioration after cycles 2 and 4 and at 3 months post‑chemotherapy.
No major AEs, but a relatively high dropout rate
AE rates were comparable between groups (p=0.115), and most AEs were of grades 1–2.
Although there were no major AEs, the scalp-cooling group had a 30 percent dropout rate, possibly due to traditional beliefs linking cold exposure with "tou feng" (literally meaning head wind), poor health, and diminished immune function.