Do you ever offer scalp cooling therapy to metastatic breast cancer patients wishing to avoid alopecia?

I routinely offer scalp cooling to such patients. I do acknowledge to patients that we do not have evidence to support scalp cooling in the metastatic setting, that the best evidence to support its efficacy is with taxane-based regimens, and that we really cannot be sure how or if scalp cooling will work when the duration of therapy is indefinite. And of course, counsel them about the standard drawbacks of additional cost, time in infusion, and potential discomfort. The therapies I have most commonly used scalp cooling with in the metastatic setting are Taxol and eribulin. Purely anecdotally, I have had patients use scalp cooling on both agents for a number of months with very minimal hair thinning. We have a clinical trial ongoing (NCT0498...