Abstract PS1-01-01: Evaluating the use, self-reported outcomes, and cost of using scalp cooling in a prospective survey study of young women with early-stage breast cancer

Abstract Background: Hair loss is a significant quality of life issue for women with breast cancer (BC) and may be particularly distressing for young women. Scalp cooling (SC) is effective at preventing chemotherapy (CT)-induced alopecia, and studies suggest improved quality of life in patients who have undergone successful SC. However, SC is rarely covered by insurance. The decision to use SC is personal. We aimed to understand how young women navigate the decision to use SC during CT, and self-reported estimates of hair loss, hair recovery, and cost at 1-year follow-up (FU). Methods: This is a single-institution prospective registry of young women diagnosed with early BC <45 yrs of age. Patients (pts) diagnosed within 6 months were eligible for study entry. This analysis included pts who received CT. Electronic surveys were administered at baseline (BL) and 1-year FU, which included questions about SC use, efficacy, satisfaction, and cost. Anxiety and depression were assessed through validated PROMIS measures. Pearson chi-squared, Kruskal-Wallis, and linear regressions statistics were used to test for associations between SC, PROMIS scores, and pt characteristics. SC devices included Penguin, DigniCap, or other systems. Results: Between May 2018 and May 2025, 265 pts who received neo/adjuvant CT were enrolled in the Young Women’s Registry. Of the 265 pts, 202 completed BL and/or 1-year FU surveys. Median age was 38 years; 60% White, 23% Asian, 3% Black, 8% Hispanic/Latina. 45% of pts had HR+/HER2- tumors, 23% TNBC, and 32% HER2+. 14% were single, 56% had children. 143 (71%) had an annual income >$100,000, 180 (89%) held college or higher degrees. Of pts that used SC, 31% received AC-containing and 69% receivednon-AC-containing CT. Pts who received non-AC regimens were more likely to use SC (p=0.046). Of 202 pts, 106 (52%) used SC. SC use was not associated with age, income, education level, having children, relationship status, or race. Depression and anxiety were assessed at BL using PROMIS measures in 129 pts. Pts that planned to use SC had higher anxiety (p=0.046), but no association with depression scores was evident (p=0.169). 75 of 106 (71%) pts who used SC completed a 1-year FU survey. 6% of pts reported losing <10% of their hair during CT, 19% reported 10-24%, 15% reported 25-49%, 32% reported 50-74%, 22% reported 75-99%, and 6% reported losing 100% of their hair (3/5 pts had received AC). When asked about satisfaction with SC use, 26% stated they were extremely satisfied, 38% were satisfied, 22% were neutral, and 14% were dissatisfied. 79% reported they would use SC again, 21% said they would not. At 1-year FU, 43% reported that their hair was back to BL, 37% recovered most, 13% recovered some, and 7% recovered a little of their hair. No pts reported that they had not recovered any hair. Pts with less hair loss were more likely to report satisfaction with SC use (p<0.001). PROMIS Anxiety and Depression scores at 1-year FU were not associated with degree of self-reported hair loss or recovery. Pts were asked about out-of-pocket SC expenses. 15% reported spending < $1,000, 23% spent $1,000-1,999, 30% spent $2,000-2,999, 18% spent $3,000-3,999, 7% spent $4,000-4,999, and 7% spent > $5,000. There was no association between out-of-pocket expense and satisfaction with SC at 1-year FU. Conclusions: In this prospective, single institution young women’s study, 52% chose to use SC. Higher rates of BL anxiety were associated with a plan to use SC. Despite SC use, some pts reported significant hair loss, with 28% reporting loss of > 75% of their hair. At 1-year FU, the majority (68%) were satisfied with their SC experience, however hair loss, hair regrowth, and cost varied widely. SC is an important option for young pts. These data can improve shared decision-making around the use of SC. Techniques to improve efficacy are still needed. Citation Format: S. Krasnegor, A. Paciorek, K. H. Natsuhara, K. Kuwahara, K. Blevins, K. Blum, M. Kim, H. S. Rugo, M. Melisko, M. Majure, L. A. Huppert, H. Batra-Sharma, L. J. Esserman, A. Chien. Evaluating the use, self-reported outcomes, and cost of using scalp cooling in a prospective survey study of young women with early-stage breast cancer [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2025; 2025 Dec 9-12; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2026;32(4 Suppl):Abstract nr PS1-01-01.