Can Scalp Cooling Help Keep My Hair During Chemotherapy?

 Elaine K. Howley
  4th-Dec-2017

When Elizabeth Stepp, a corporate litigator in Dallas, found out she had breast cancer, the prospect of undergoing chemotherapy upset her greatly. “At first there was this question – they didn’t think I would need chemo and then I did,” she says, noting that she eventually had 16 rounds of Adriamycin, a powerful type of chemotherapy. “When I went to the oncologist’s office and learned the cancer had spread to my lymph nodes, I started crying. It kind of surprised everyone in the room including me.” She says two common side effects of chemotherapy were the trigger for those tears: chemo-brain, a usually subtle but pervasive fogginess that some patients experience as a result of treatment, and hair loss.

“The hair, that surprised me,” Stepp says, noting that she’s not vain and doesn’t spend much time or energy on her hair. “Really, if I comb my hair on an average day, I consider that a good thing,” she says. But still, she was bothered by the prospect of losing her hair.

For Stepp and many other women, the issue isn’t about looks but rather about wrestling back some measure of control from a disease that can leave them feeling powerless. Dr. Maryam Lustberg, associate professor of medicine and medical director of survivorship at the Stefanie Spielman Comprehensive Breast Center at the Ohio State University James Cancer Hospital, says “it’s really important to emphasize that it’s not about vanity. It’s not just hair.” She compares it to open heart surgery. “When you’re walking across the grocery store, not everyone can see your surgery scar. But when you’re going through chemo and you lose your hair, even if you have the best wig or the best scarf, people instantly know something is going on with your health. They often want to have a conversation about it, and it can be very intrusive.”

For Stepp, it wasn’t just questions from strangers she hoped to avoid. To succeed in her job, she has to project an air of strength and authority, and she says that walking into court bald, wearing a head scarf or wearing an obvious wig would be a bright signal to opposing counsel that she might be weak or vulnerable in some way. Having an option to help sidestep that possibility was worth exploring, she says.

While extensive hair loss was once considered an unavoidable aspect of chemotherapy treatment, over the past 15 years or so, some patients have had success in keeping some of their hair through the use of an innovative solution called scalp cooling or cold capping. Lustberg says scalp cooling is “a true advance in how we deliver care,” although it doesn’t work in every case and most patients still lose some of their hair. “We’re not completely preventing hair loss, but depending on the chemo drugs, we’re able to reduce scalp hair loss. For many patients, we’re able to prevent the need for them to wear a wig. Their own hair can still be a little thinner, but for many women it’s a very successful intervention where people don’t even realize they’re going through chemo.”

Breastcancer.org describes cold caps and scalp cooling systems as “tightly fitting, strap-on, helmet-type hats filled with a gel coolant that’s chilled to between -15 and -40 degrees Fahrenheit.” (Although these temperatures are low enough to cause frostbite in peripheral tissues such as fingers and toes, a 2016 study in the journal Breast Cancer Research and Treatment indicated frotsbite is unlikely to be a problem with these devices, provided they're used properly.) If you’re being treated at a major cancer center, they may have what Lustberg describes as a “central device” – a machine that the cap is plugged into that delivers continuous cooling to the cap and the scalp. DigniCap and Paxman are two names you may hear in relation to these devices. Smaller or rural cancer centers are less likely to have the central device, but some women have used a DIY-style approach to cold capping by renting a cap package from one of several providers such as Penguin Caps, Chemo Cold Caps or the Rapunzel Project. With this approach, a series of about six caps are super cooled with dry ice then placed on the head over wet hair one at a time. They’re rotated out every 15 or 30 minutes as they warm so that continuous cold is delivered to the scalp.

In Stepp’s case, she rented caps from a company based in Dallas and her husband and friends helped her switch out the caps as needed during treatment, which gave them something very practical to do rather than just sit and worry. She says she “lost about 70 percent of my hair. It was very thin in the end, but I had a lot of hair to start with,” and she felt that losing 70 percent was preferable to losing 100 percent of her hair as most patients on her chemotherapy regimen do. She felt the results were acceptable, and the only people in her professional sphere who knew about her cancer were those she told on her own terms.

The advantage with the central device approach is that there’s less labor involved because the patient doesn’t have to keep switching caps and the circulating coolant keeps the temperature constant. Cold capping on your own can also be expensive and may not be covered by insurance. Stepp says the system she used cost about $500 per month to rent on pay-as-you-go terms, so if it stopped working and her hair fell out, she could return the caps and not need to pay any more money.

Regardless of whether patients use a central device cooling cap system or a rotation of dry ice–cooled caps, the concept behind how they work is the same, and fairly simple. “By cooling the scalp, we are reducing the accumulation of the chemo drug in the follicles,” Lustberg says. Reducing the temperature of the scalp constricts the blood vessels that feed the hair follicles and that prevents most of the drug from reaching the hair follicles. Some of the drug will still reach the follicles, but cold cells are less likely to absorb it when it arrives.

Breastcancer.org reports that “the cold also decreases the activity of the hair follicles, which slows down cell division and makes the follicles less affected by the chemotherapy medicine.” Unlike newer treatments for cancer, cytotoxic chemotherapy drugs are not targeted specifically to cancer cells, but instead kill any and all quickly dividing cells in the body. The cells that create our hair and nails divide rapidly, as do cells in the lining of the digestive tract. This is why many patients experience hair loss, damage to the nails and nausea or vomiting as side effects of chemotherapy

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