Access to scalp cooling for chemotherapy-induced alopecia prevention differs by geography

Access to scalp cooling therapy for patients undergoing chemotherapy is affected by geographic location, according to a study.

“Chemotherapy-induced alopecia (CIA) is one of the most stigmatized and psychologically challenging experiences for patients undergoing cancer treatment, with some women refusing chemotherapy because of the risk of alopecia,” Sean Singer, MD, of the department of internal medicine at Brigham and Women’s Hospital in Boston, and colleagues wrote. “Scalp cooling can prevent or decrease the extent of hair loss in patients receiving cytotoxic chemotherapy, eliminating the need for a wig in up to 66% of patients on some regimens.”

Despite its prevalent use in other countries, the United States has been slower to introduce scalp cooling therapy, according to the study, which identified cancer treatment centers that offered the treatment using data from the nonprofit organization The Rapunzel Project.

Medicare Part B claims were also requested to evaluate the location of scalp cooling centers compared with where chemotherapy infusions were occurring.

There are 366 chemotherapy centers in the U.S. that offer scalp cooling therapy, most of which are located in coastal states and urban areas. No scalp cooling centers were found in six states with an additional seven states having only one cooling center in the entire state.

Of Medicare-billed chemotherapy infusions, 73.9% were conducted in a zip code that did not have a scalp cooling center.

For 43.9% of Medicare-billed chemotherapy infusions, scalp cooling is available less than 12.5 miles away, while it is available between 12.5 and 49.9 miles for 24.8%. For 31.3% of infusions, no scalp cooling is available within 50 miles.

The southern states have the most chemotherapy infusions occurring more than 50 miles from a scalp cooling center, while the Midwest has the greatest percentage of infusions occurring more than 50 miles from a cooling center.

Suburban (59.9%) and rural zip codes (80.8%) were most likely to be at least 50 miles from a scalp cooling center.

“Increased availability of scalp cooling in suburban and rural areas would increase access for patients who may wish to preserve their hair while undergoing chemotherapy,” the authors wrote. “Economic factors may also play a significant role in patient access to scalp cooling and warrant further study.”