Assessment of long-term alopecia after adjuvant taxane therapy for early breast cancer: a cross-sectional survey

Abstract

Background: Alopecia is a distressing side-effect of taxane chemotherapy, and evidence suggests that docetaxel leads to chronic alopecia. We measured rates of satisfaction with hair regrowth among women who received adjuvant docetaxel compared with paclitaxel to identify a difference in outcomes.

Methods: We identified adult female patients who received paclitaxel or docetaxel chemotherapy for early breast cancer from 2010 to 2015. They were screened to ensure they were alive, without metastatic relapse or a new cancer. Eligible participants were sent an introductory letter, consent, a Dermatology Life Quality Index (DLQI) questionnaire, a Visual Analogue Score (VAS) and the European Organisation for Research and Treatment of Cancer (EORTC) general and breast-specific quality of life. The primary outcomes were the DLQI: a 10-item questionnaire scored on a 0-3 scale (higher scores indicating distress and dissatisfaction) and the VAS (scored out of 4). Secondary outcomes were the global health status, function, symptom score and breast specific outcomes shown by the EORTC QLQ-C30 and EORTC QLQ-BR23.

Results: There were 88 responders from 210 letters (response rate 42%); 38 (43%) had docetaxel and 50 (57%) had paclitaxel. They were aged 26-90 (median: 59). There was a significant difference in DLQI scores, with the docetaxel group having a higher median score (docetaxel: 4 vs paclitaxel: 1, p = 0.01). A significantly higher proportion of patients reported no effect of hair loss in the paclitaxel group (p = 0.02). Similarly, there was a significant difference in VAS scores with the docetaxel group having a higher median score (docetaxel: 1 vs. paclitaxel: 0.5, p = 0.002). Secondary outcomes did not reach statistical significance. There was no association with aromatase inhibitor exposure.

Conclusions: Our study shows that adjuvant docetaxel chemotherapy is associated with statistically significant higher rates of dissatisfaction and chronic alopecia than paclitaxel chemotherapy. This supports literature and should be discussed prior to administering docetaxel regimens.

Keywords: Alopecia; Chemotherapy; Hair loss; Survivorship; Taxane; Toxicity.

Fig. 1

Effects of hair loss on patient’s quality of life by taxane-chemotherapy group

Fig. 2

Permanent alopecia from docetaxel chemotherapy