Do the chemo - keep your hair? For most women, hair loss is the scariest, most dreaded side effect of chemotherapy. A new adjunct therapy may help you go through chemo and still keep your locks.
I serve as a patient representative on a patient and family advocacy committee at our local cancer center.
One of my fellow patient representatives, Ginny, went through breast cancer - including chemotherapy - a year ago. Surprisingly, her hair is gorgeous - shoulder length, shiny, healthy looking.
For those of you who've lost your hair to chemo, you know that's pretty unusual - in fact, nigh on impossible, just a year after treatment.
So I asked her how she'd done it. "Ginny, how can your hair possibly look this good with your having had chemo so recently?"
"I didn't lose my hair."
Now, it's true, not all chemo regimens cause hair loss. But nearly all do; and those that don't produce at least thinning hair, hair that's lost its healthy shine.
Ginny went on to tell me that she'd tried a new therapy during chemo, something called a "cold cap" - literally, a tight-fitting cap (think something between a bike helmet and a bathing cap) cooled to -25 °F, and worn during the administration of chemo.
The result? Blood flow to Ginny's scalp was reduced, and toxic chemo drugs didn't reach the hair follicles in her head; her hair remained healthy. And beautiful.
Cold caps have been helping women in Canada and Europe for some time; they don't always prevent hair loss 100%, and aren't appropriate for every type of chemo. But those who try them clearly appreciate keeping most (or even all) of their hair.
Unfortunately, they've yet to gain FDA approval in this country. So Ginny Reed is out to change that, by spreading the word in the cancer community about the effectiveness of the caps, hoping a groundswell of public opinion may hasten the FDA's examination (and approval) of the cap, making it eligible for insurance coverage.
And Ginny - otherwise known as Virginia Reed, PhD, MPH, associate professor of community & family medicine, and research associate professor of psychological & brain sciences, The Geisel School of Medicine at Dartmouth - has the cred to do just that.
Ginny shared with me a 24-page "Bibliography Of The Research, Effectiveness, And Safety Of Scalp Cooling" that she's compiled. "My hope is that women will pass the reference on to their providers and institutions," she says. "Ultimately, it would be great if those providers and institutions made the info. available. My goal is to educate and empower women - once they have the facts, whatever they choose for themselves is the best decision."
I read this exhaustive bibliography, and am impressed by the number of worldwide studies already done that support the cold cap's effectiveness. Best results are obtained by women being treated with a taxane (taxol or taxotere); worst results, by those receiving a combination of a taxane plus adriamycin and/or cytoxan. Cold caps were also effective for women receiving "imtermediate" doses of a taxane, adriamycin, or cytoxan alone, rather than in combination. (Reed, 2013)
But are they safe? If chemo doesn't reach all areas of your body, is there a possibility breast cancer could spread to your scalp?
Yes, it's possible for breast cancer to metastasize to the scalp; but it's exceedingly rare, and no more common in women who've tried the cold cap than in those who haven't. In addition, scalp metastasis always occurs at the same time (or after) another metastasis elsewhere in the body (Reed, 2013); so scalp metastasis wouldn't be considered a primary metastasis.
Currently, some American women are renting Penguin Cold Caps from a company in Great Britain, at a cost of $455 a month. Multiple caps are necessary for each chemo infusion; the extras need to be stored on dry ice (or in special freezers some hospitals provide), so it's a process usually requiring a friend to help. But women want to save their hair, and thus are willing to do whatever it takes. (Neergaard, 2013)
Dignitana AB, Swedish manufacturer of the DigniCap cold cap, has received FDA permission to conduct a second and final phase study in an effort to gain approval to market the caps in the U.S. Perhaps it won't be long before some American breast cancer survivors, like their Canadian and European counterparts, will be able to undergo chemo without the stigma, embarrassment, and discomfort of a bald head.
Want to learn more about cold caps? The following is an excerpt from Ginny's bibliography.
Cold cap use and availability in the U.S.
Most users of cold caps in the U.S. use caps that rely on dry ice or biomedical freezers to achieve and maintain the temperature required for scalp cooling. Penguin Cold Caps may be rented while Elastogel caps may be purchased.
User information, reviews, and support are available through the "Cold cap users - past and present" discussion board at breastcancer.org.
At the present time, caps that provide hypothermia through a cooling system are available to the general public only outside the U.S. through Paxman and Dignitana.
Neergaard, L. (2013, October 17). Will chilling the head during chemo save hair? Cape Cod Times, pp. C-1.
Reed, V. (2013). A bibliography of the research, effectiveness, and safety of scalp cooling.