Currently submitted to: JMIR Cancer
Date Submitted: Mar 4, 2026
Open Peer Review Period: Mar 4, 2026 - Apr 29, 2026
(closed for review but you can still tweet)
NOTE: This is an unreviewed Preprint
Warning: This is a unreviewed preprint (What is a preprint?). Readers are warned that the document has not been peer-reviewed by expert/patient reviewers or an academic editor, may contain misleading claims, and is likely to undergo changes before final publication, if accepted, or may have been rejected/withdrawn (a note "no longer under consideration" will appear above).
Peer review me: Readers with interest and expertise are encouraged to sign up as peer-reviewer, if the paper is within an open peer-review period (in this case, a "Peer Review Me" button to sign up as reviewer is displayed above). All preprints currently open for review are listed here. Outside of the formal open peer-review period we encourage you to tweet about the preprint.
Citation: Please cite this preprint only for review purposes or for grant applications and CVs (if you are the author).
Final version: If our system detects a final peer-reviewed "version of record" (VoR) published in any journal, a link to that VoR will appear below. Readers are then encourage to cite the VoR instead of this preprint.
Settings: If you are the author, you can login and change the preprint display settings, but the preprint URL/DOI is supposed to be stable and citable, so it should not be removed once posted.
Submit: To post your own preprint, simply submit to any JMIR journal, and choose the appropriate settings to expose your submitted version as preprint.
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Beyond Hair Preservation: Scalp Cooling as a Biopsychosocial Intervention in Patients Receiving Highly Alopecia-Inducing Chemotherapy
ABSTRACT
Background:
Background:
Chemotherapy-induced alopecia is among the most psychologically distressing adverse effects of systemic cancer therapy. Although scalp cooling is increasingly used to mitigate hair loss, it is still largely perceived as a cosmetic intervention. Its broader psychological relevance and the biological basis of treatment success, particularly the preservation of follicular integrity under ongoing cytotoxic exposure remain insufficiently explored.
Objective:
Objective:
This study aimed to reconceptualize scalp cooling beyond visible hair preservation by examining its psychological impact in patients receiving highly alopecia-inducing chemotherapy, while integrating quantitative objective hair preservation metrics with structural and ultrastructural analyses of hair follicle damage to identify avenues for improving follicular integrity and scalp cooling efficiency.
Methods:
Methods:
82 patients undergoing highly alopecia-inducing chemotherapy consisting of sequential anthracycline-taxane regimen (four cycles of epirubicine and cyclophosphamide followed by 12 weekly paclitaxel applications) received standardized scalp cooling. Objective hair preservation was quantified using the Hair Mass Index (HMI) as a standardized and reproducible measure of hair retention. Structural and ultrastructural follicular integrity was assessed using light microscopy as well as scanning and transmission electron microscopy. Objective hair preservation metrics were analyzed in relation to patient-reported quality-of-life outcomes (EORTC-based measures), subjective treatment burden, and cognitive appraisal of the scalp cooling experience. Multivariable regression models were applied to identify determinants of post-therapeutic quality of life.
Results:
Results:
Visible chemotherapy-induced alopecia was successfully prevented in more than half of the treated patients. Scalp cooling resulted in substantial objective hair preservation as quantified by the Hair Mass Index; however, HMI values showed only a limited association with post-therapeutic quality-of-life outcomes. In contrast, cognitive appraisal of scalp cooling emerged as a central determinant of post-therapeutic quality of life, independent of the degree of objective hair retention. Structural and ultrastructural analyses demonstrated that preservation of follicular integrity was closely associated with successful macroscopic hair retention under ongoing cytotoxic exposure, supporting a biological basis for the clinical effectiveness of scalp cooling.
Conclusions:
Conclusions:
The clinical relevance of scalp cooling extends beyond objective and visible hair preservation and appears to reside predominantly in its psychological impact on patients undergoing highly alopecia-inducing chemotherapy. Importantly, the identification of structural and ultrastructural markers of follicular vulnerability provides a mechanistic foundation for the future optimization of scalp cooling approaches and for the development of adjunct follicle-directed protective strategies to enhance follicular integrity and support patient well-being during cytotoxic therapy.
Citation
Request queued. Please wait while the file is being generated. It may take some time.
Copyright
© The authors. All rights reserved. This is a privileged document currently under peer-review/community review (or an accepted/rejected manuscript). Authors have provided JMIR Publications with an exclusive license to publish this preprint on it's website for review and ahead-of-print citation purposes only. While the final peer-reviewed paper may be licensed under a cc-by license on publication, at this stage authors and publisher expressively prohibit redistribution of this draft paper other than for review purposes.