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Brief Report
March 6, 2019

Assessment of Quality of Life and Treatment Outcomes of Patients With Persistent Postchemotherapy Alopecia

Author Affiliations
  • 1Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
  • 2Dermatology Service, Hospital Vithas Santa Catalina, Gran Canaria, Canary Islands, Spain
  • 3Departments of Oncodermatology and Clinical Research, Institut Claudius Regaud, Institut Universitaire du Cancer, Toulouse Oncopole, France
  • 4The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York
  • 5Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
  • 6Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine Miami, Florida
  • 7Center for Clinical Epidemiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
  • 8Welch Center for Epidemiology, Prevention, and Clinical Research, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
  • 9Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
  • 10Department of Medicine, Weill Cornell Medical College, New York, New York
  • 11Dermatology Research Centre, University of Manchester, National Institute for Health Research Manchester Biomedical Research Centre, Manchester, United Kingdom
JAMA Dermatol. 2019;155(6):724-728. doi:10.1001/jamadermatol.2018.5071
Key Points

Question  What is the quality of life of patients with persistent alopecia after chemotherapy, and what is their response to dermatologic therapy?

Findings  In this cohort study, patients with persistent chemotherapy-induced alopecia showed a predominantly diffuse and more severe alopecia than did patients with endocrine therapy–induced alopecia that developed after completion of chemotherapy, although a negative emotional effect was found in both groups. After treatment with topical minoxidil as a single agent or in combination with oral spironolactone, mild to moderate improvement was observed in both groups.

Meaning  It is important to consider the clinical features and the time to development of alopecia to minimize nonadherence to adjuvant therapies.


Importance  Persistent alopecia occurs in a subset of patients undergoing chemotherapy, yet the quality of life (QOL) of these patients and their response to therapy have not been described in a large patient cohort.

Objective  To characterize the clinical presentation of patients with persistent chemotherapy-induced alopecia (pCIA) or endocrine therapy–induced alopecia after chemotherapy (EIAC) and their QOL and treatment outcomes.

Design, Setting, and Participants  A retrospective multicenter cohort of 192 women with cancer treated with cytotoxic agents who received a clinical diagnosis of persistent alopecia (98 with pCIA and 94 with EIAC) between January 1, 2009, and July 31, 2017, was analyzed. All patients were from the dermatology service in 2 comprehensive cancer centers and 1 tertiary-care hospital. Data on demographics, chemotherapy regimens, severity, clinical patterns, and response to hair-growth promoting agents were assessed. Data from the Hairdex questionnaire were used to assess the QOL of patients with alopecia.

Main Outcomes and Measures  The clinical presentation, response to dermatologic therapy, and QOL of patients with pCIA were assessed and compared with those of patients with EIAC.

Results  A total of 98 women with pCIA (median age, 56.5 years [range, 18-83 years]) and 94 women with EIAC (median age, 56 years [range, 29-84 years]) were included. The most common agents associated with pCIA were taxanes for 80 patients (82%); the most common agents associated with EIAC were aromatase inhibitors for 58 patients (62%). Diffuse alopecia was predominant in patients with pCIA compared with patients with EIAC (31 of 75 [41%] vs 23 of 92 [25%]; P = .04), with greater severity (Common Terminology Criteria for Adverse Events, version 4.0, grade 2) among patients with pCIA (29 of 75 [39%] vs 12 of 92 [13%]; P < .001). A negative emotional effect was reported by both groups. After treatment with topical minoxidil or spironolactone, moderate to significant improvement was observed for 36 of 54 patients with pCIA (67%) and for 32 of 42 patients with EIAC (76%).

Conclusions and Relevance  Persistent chemotherapy-induced alopecia is frequently more severe and diffuse when compared with EIAC, and both groups of patients experienced a negative effect. A modest benefit was observed with dermatologic therapy. Additional studies are warranted to develop effective strategies for prevention and effective therapy for pCIA and EIAC.

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