You’ve been diagnosed with cancer. Your oncologist says you need chemotherapy. What’s your biggest fear — illness? Loss of work? Pain?
For many people with breast cancer who are undergoing chemo, one of the biggest concerns is hair loss. According to the American Society of Clinical Oncology, treatment with most breast cancer drugs results in anything from hair thinning to total loss of hair body-wide. Fifty percent of women advised to have chemotherapy report hair loss as their biggest fear, according to an editorial in the Journal of the American Medical Association, and up to 8 percent claim it’s enough to stop them from undergoing the therapy, despite their doctor’s recommendation.
Clearly, hair loss as a result of chemotherapy is a serious emotional and physical issue for people with cancer, and a matter of concern to doctors worried about their cancer patients obtaining the best treatment possible.
Cold caps can help prevent hair loss
Enter the cold cap, an innovative technology focused on preserving a person’s hair during chemo. Simply put, a super-cooled strap-on cap worn on the head during chemo constricts blood vessels leading to hair follicles, which restricts the flow of drugs into those follicles. In addition, the cold slows down cellular activity in hair follicles, which means they react more slowly to any chemo that does manage to get through.
The result? A lower chance of hair loss. About 50 to 65 percent of women (depending on the exact chemo drugs they take) can expect to keep 50 percent or more of their hair. So although the cold cap isn’t 100 percent effective for all women, it’s a huge step in the right direction.
At first, some clinicians expressed concern that women using cold caps weren’t getting chemo’s full benefit, as far as decreasing breast cancer risk. But according to a 2015 study in Breast Cancer Research and Treatment, using cold cap technology doesn’t negatively impact survival rates for breast cancer patients.
“Cold caps have been used for decades in Europe,” Virginia A. Reed, Ph.D., told HealthCentral. “And their use in the U.S. has increased rapidly in the past five years.”
Reed, an associate professor of community and family medicine at Dartmouth College’s Geisel School of Medicine, used a cold cap while receiving chemotherapy for breast cancer five years ago. She kept her hair, and has gone on to become a leading advocate for the technology. Her bibliography of research around scalp cooling for hair retention during chemotherapy is a wealth of information for both patients and clinicians.
The original cold cap system
The original cold cap system, and one still in use in many places, consists of a series of gel-filled caps frozen to -22°F that a woman wears in sequence, 30 minutes each cap, during chemo. The therapy starts about an hour before treatment and concludes about an hour afterward.
The main issue with this type of cold cap is the need for multiple caps, which the patient must purchase and maintain herself, and the necessity to keep them frozen. Women using this method come to treatment with the caps packed in dry ice and require logistical help from a personal support crew.
Thankfully, hospitals have increasingly added biomedical freezers to their chemotherapy facilities, so dry ice is no longer needed. But the manual cold cap is still an expensive and labor-intensive therapy, and one whose cost isn’t usually covered by health insurance.
Current technology for hair loss prevention
Since 2015, the Food and Drug Administration (FDA) has approved two new cold cap systems: DigniCap and the Paxman Scalp Cooling System. This approval has been critical because it’s much more likely insurance will pay for FDA-approved treatment. Both systems work by circulating coolant at -22°F through channels in a snug-fitting silicone cap. There’s no need for dry ice, a biomedical freezer, or multiple caps, so the logistics are much easier.
While cold caps have been in use in Europe since the 1970s, the technology has only been available in the U.S. since the early 2010s, and, due to its cumbersome nature, it wasn’t widely embraced. Thanks to FDA approval, though, treatment centers are now able to offer the simpler DigniCap and Paxman therapies to their chemo patients. Currently, more than 250 hospitals and cancer treatment centers across the U.S. offer some form of access to either this improved technology or a biomedical freezer for women wishing to provide their own caps.
Want to explore using cold cap therapy during chemo? Speak with your oncologist. They can ensure it’s a good option for you, and if it is, explain what (if any) technology is available at your hospital or treatment center.
Looking for news updates and further information about cold caps? The Rapunzel Project is a nonprofit organization “dedicated to chemotherapy patients keep their hair during treatment.”
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PJ Hamel is senior digital content editor and food writer at King Arthur Flour, and a James Beard award-winning author. A 16-year breast cancer survivor, her passion is helping women through this devastating disease. She manages a large and active online survivor support network based at her local hospital and shares her wisdom and experience with the greater community via HealthCentral.com.