Geographic Disparities in Access to Scalp Cooling for the Prevention of Chemotherapy-Induced Alopecia in the United States

Introduction: Chemotherapy-induced alopecia is psychologically challenging for patients undergoing cancer treatment, and scalp cooling has been shown to prevent or decrease the hair loss.

Methods: Cancer treatment centers offering scalp cooling were identified using data from The Rapunzel Project. Medicare claims data were queried to evaluate the number of chemotherapy infusions occurring in each zip code in the US. Geographic distribution of chemotherapy infusions and scalp cooling centers was determined using ArcGIS software. The average distance from the geographic center of all 5-digit zip codes in which chemotherapy infusions occur to the nearest scalp cooling center was calculated in miles.

Results: There are 366 chemotherapy infusion centers in the United States that offer scalp cooling. 43.9% of Medicare-billed chemotherapy infusions in the United States occur in zip codes less than 12.5 miles from a scalp cooling center, 24.8% occur between 12.5 and 49.9 miles away, and 31.3% occur greater than 50 miles away.

Limitations: Our results are only generalizable to patients seen at Medicare-accepting institutions in the US.

Conclusions: Geographic disparities affect which patients can access scalp cooling therapy, and implementation in suburban and rural areas would increase access for patients who wish to preserve their hair while undergoing chemotherapy.

Keywords: Medicare; accessibility; alopecia; cancer care disparities; chemotherapy-induced alopecia; cutaneous toxicities; rural; scalp cooling; supportive care; urban.