Cold Caps and Hair Loss

If you have experienced chemotherapy treatment for breast cancer in the past few years, you will most likely have heard of cold caps, devices which are used to try and prevent or retard the hair loss commonly associated with toxic chemotherapy drugs. The use of this technology is expanding as its positive effects are being corroborated by both scientific research and widespread anecdotal evidence. More and more companies are beginning to develop new cold cap products as the market for them grows.

What are Cold Caps?

Cold caps or “cooling caps” are used to mitigate the effects of chemotherapy drugs on the hair follicles of patients. This technique is also known as “scalp hypothermia,” because the scalp is cooled to between -15 and -40 degrees Fahrenheit, much lower than its usual temperature.

Today, the caps are usually composed of a gel or fluid that can be circulated through the cap using a mechanical system which continually cools it. This is different from earlier version of the caps which were more like ice packs and needed to be changed out and discarded multiple times during every chemotherapy session, which can last more than three hours, in order to maintain the low temperature. The cap is generally put on 20 to 50 minutes before chemotherapy begins and left on for a variable period afterwards to ensure its maximum effectiveness.

How Cold Caps Can Help Prevent Hair Loss

Cold caps are designed to work by constricting the blood vessels that lead into the scalp and hair follicles during the administration of a chemotherapy drug, such as Taxotere. Theoretically, this constriction will prevent the blood, which is carrying the toxic drug through the body, from reaching the hair follicles. Since less of the drug is reaching the hair follicles, the process should lessen the effect that the drug has on them. In addition, the cold temperature is designed to decrease activity in the scalp which slows down the replication process of the hair follicle cells, which usually divide particularly quickly. Since chemotherapy targets cells that grow and divide rapidly, slowing down the rate of division using cold caps may help prevent chemo drugs from targeting those cells.

To support the process of hair retention, women who use cold caps will be advised by their doctor to take particular care of their hair during the course of their treatment. These steps can contribute to maintaining a patient's hair:

  • No heat treatments such as blow drying, hot rollers, or straightening irons
  • Low frequency hair washing with gentle shampoos
  • Avoid coloring the hair until 3 full months after the chemotherapy regimen is completed
  • Careful combing and brushing

Current Research

A substantial amount of new research has come out recently supporting the effectiveness of scalp hypothermia during chemotherapy treatments. The University of California in San Francisco published a study in early 2017 supporting cooling systems in the Journal of the American Medical Association. They studied 122 women with stage 1 or stage 2 breast cancer who used DigniCap during their chemotherapy treatment. 5% of the women who used the cold caps experienced no hair loss and 36% lost only 25% or less of their total hair volume. All the women who did not use the cooling system lost most or all of their hair.

Similarly, a study from Baylor University found that cooling caps may help reduce the rate of hair loss in breast cancer patients who undergo chemotherapy treatment. This study looked at the effectiveness of the Paxman Scalp Cooling System, which is currently under review by the FDA. In this study, of 142 women who participated, 50% retained more than 50% of their hair. Although most women will undergo chemotherapy regardless of the side effects, there is “a small percentage of women that will decline chemotherapy because they don't want to lose their hair.” This treatment option may encourage more women to make empowered decisions about their health.

Drawbacks of Cold Caps

While the benefits of these systems are being recognized more and more in mainstream cancer treatment, and systems are being improved constantly, there is still some discomfort with the current system. Since the treatment is so far below the scalp's normal body temperature, some women will become very cold and may develop headaches. Also, women with thicker hair may find the treatment less effective because the scalp is more insulated and therefore not as affected by the cooling treatment.

In addition, as it now stands, most insurance companies will not pay for the treatment. Individuals have two main options. They can purchase or rent their own cooling caps online from private companies, or, in some cases, hospitals or cancer treatment centers have their own cooling systems which can be used by patients for an out of pocket cost. Right now, 50 medical centers in 17 states have the only FDA approved cooling system, called DigniCap. The treatments generally cost between $1,500 and $3,000 per patient, depending on the number of rounds of chemo they must undergo.

The Importance of Access to Cooling Systems

Cold caps have been in use in many parts of Europe since the 1970s. Older studies sometimes have conflicting results about the effectiveness of this technology, but it is not shown to do any harm or allow cancer to survive in the hair follicles, which was an early concern. Basically, cooling systems may not work for everyone, but they are effective enough to be presented as an important treatment option for women who are concerned with hair loss. In particular, when a drug like Taxotere may cause permanent hair loss, the option to prevent this side effect becomes even more important. Many women who did not opt to use cold caps at the time of their treatment may not have done so because they believed the hair loss would be temporary. Knowing that permanent hair loss was a realistic possibility, many women may have chosen to invest in cooling systems that would have given them a chance at preserving their appearance.

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