An interview-based qualitative study of scalp cooling, alopecia, and disparities in Black breast cancer patients

BACKGROUND: Existing quality-of-life assessment tools for chemotherapy-induced alopecia may not adequately serve women of all races. Non-White patients with breast cancer receiving chemotherapy at our institution were approximately six times less likely than White patients to use scalp cooling (SC). OBJECTIVE: This study examines factors contributing to this disparity through interviews with Black women undergoing chemotherapy, focusing on alopecia's impact and attitudes toward its prevention and treatment. METHODS: Semi-structured, 1-hour Zoom interviews were conducted and transcribed. Content analysis using NVIVO software and a grounded theory approach identified themes. RESULTS: Three main domains emerged: (1) alopecia's impact, (2) barriers to SC, and (3) improving alopecia management. Key barriers included limited representation of Black women in SC advertising and concerns about SC's effectiveness on textured hair. Solutions included better counseling on SC use, camouflage options, and increased awareness of other treatment options like dermatology referrals. LIMITATIONS: The study was conducted at a single institution; participation was voluntary leading to possible selection bias and the risk for recall bias in the setting of assessing patients' attitudes retrospectively. CONCLUSION: This study highlights barriers to SC use among Black women, providing insights for developing interventions to improve access to alopecia prevention and treatment.