Clinical Practice Guidelines

Globally recommended clinical guidelines for the use of scalp cooling with specific cancer treatments

The National Comprehensive Cancer Network® (NCCN®) Guidelines

The NCCN Guidelines now recommend scalp cooling as a category 2A treatment option for patients with invasive breast cancer and Ovarian Cancer, Fallopian Tube Cancer and Primary Peritoneal Cancer.

The National Comprehensive Cancer Network® (NCCN®) has updated the Clinical Practice Guidelines in oncology for breast cancer (Version 1.2019) to include scalp cooling as a Category 2A recommendation to reduce the incidence of chemotherapy-induced alopecia for patients receiving chemotherapy.[1] Subsequently, the Guidelines in oncology for Ovarian Cancer, Fallopian Tube Cancer and Primary Peritoneal Cancer were also updated to include scalp cooling as a Category 2A recommendation to reduce the incidence of alopecia for patients receiving chemotherapy with high rates of alopecia. (Version 1.2020).

Who are the NCCN?

The National Comprehensive Cancer Network® (NCCN®) is a not-for-profit alliance of 28 leading cancer centers devoted to patient care, research, and education. NCCN is dedicated to improving and facilitating quality, effective, efficient and accessible cancer care so that patients can live better lives.

Guidelines Detail

The European Society for Medical Oncology (ESMO) Guidelines

ESMO published the following guidelines for preventive management of CIA:

‘Scalp cooling is the only method that has been shown to prevent CIA, at least to a certain extent. Seven out of eight randomised clinical trials resulted in a significant advantage for scalp-cooled patients with 50%-65% of patients developing grade 1 alopecia. In addition, many observational studies and reviews showed the efficacy of scalp cooling using gel caps or devices for a broad range of cytostatics for patients with all stages of various cancers. Scalp cooling has shown greater efficacy with taxane-based regimens, and lower efficacy when anthracyclines are combined with taxanes or with cyclophosphamide.’ [2]

Who is ESMO?

ESMO is the leading professional organisation for medical oncology. With more than 25,000 members representing oncology professionals from over 160 countries worldwide, ESMO is the society of reference for oncology education and information.

Prevention and Management of Dermatological Toxicities RelatedPaper: Prevention and management of dermatological toxicities related to anticancer agents

Cancer Australia Guidelines

The Cancer Australia Guidelines published in 2020, contains a list of recommendations and practice points that have been developed to assist health professionals in the management and care of early breast cancer.
The purpose of this Guidance is to provide health professionals with up-to-date evidence-based guidance for the management of patients with early breast cancer that is relevant to the Australian health care setting. This Guidance aims to support the delivery of best practice patient-centred care and to assist health professionals and patients in shared decision-making regarding the management of early breast cancer. Under Chemotherapy in the guidelines for Systemic Therapy, they make the recommendation:

“Consider scalp cooling to reduce the risk of hair loss for patients receiving chemotherapy, noting scalp cooling may be less effective with anthracycline-containing regimens.” [3]

Who are Cancer Australia?

Cancer Australia was established by the Australian Government in 2006 to benefit all Australians affected by cancer, and their families and carers. Cancer Australia aims to reduce the impact of cancer, address disparities and improve outcomes for people affected by cancer by leading and coordinating national, evidence-based interventions across the continuum of care.

Guidance for the management of early breast cancer: Recommendations and practice points | Cancer AustraliaPaper: Cancer Australia Guidelines 2020 - Guidance for the management of early breast cancer

German Guideline Program in Oncology (GGPO) Guidelines

In their guideline for Supportive Therapy in Oncology Patients, the GGPO recommend for non-drug prophylaxis for alopecia:

For decades, preventive measures to prevent a CIA have been sought. In addition to medicinal procedures, all of which were largely unsuccessful, research has recently focused on cooling the scalp.

To prevent high-grade chemotherapy-induced alopecia, scalp cooling during chemotherapy can be offered after weighing the risks and benefits. [4]

Who are the GGPO?

The Association of the Scientific Medical Societies in Germany, the German Cancer Society and the German Cancer Aid jointly launched the German Guideline Program in Oncology in 2008.
The program aims to foster the development, implementation and evaluation of evidence based clinical practice guidelines in oncology.

Leitlinienprogramm OnkologieLeitlinie: Supportive Therapie bei onkologischen PatientInnen
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