Hair loss is such a common side effect of chemotherapy medication that it has become an almost universal symbol for cancer. Losing hair can add emotional distress to what is already an incredibly difficult time for patients. It is normal to feel upset about hair loss. It can take away patient privacy, forcing patients to share their condition with the world, and can impact their self-esteem. Preventing hair loss can be an effective way to empower chemotherapy patients and limit the impact of treatment to help them feel their best.
Two back-to-back studies recently published in the Journal of the American Medical Association demonstrated that by using scalp-cooling treatments, women with early-stage breast cancer have a significantly higher chance of losing less hair during chemotherapy. Scalp cooling technique, or “Scalp hypothermia” is a strategy widely used in Europe in which the scalp is cooled concurrently with and for at least 90 minutes after each chemotherapy treatment to prevent hair loss. After several minutes of exposure, most patients become accustomed to and tolerate the cold cap.
The idea is simple: the reduced temperature slows metabolism of the hair follicles so that they are less impacted by the chemotherapy agent effects on rapidly differentiating cells. The cap may also work by restricting the flow of the chemotherapy agent in the scalp by constricting blood vessels.
New automatic cooling systems include a tight fitting cap through which a liquid cooling agent is circulated, and a neoprene top piece to retain the coolness of the cap. The technology is revolutionized compared to former models which required the manual replacement of actual frozen caps periodically during treatment.
The study results are promising. Over half of the study women with stage one or two breast cancer retained more than half of their hair and five percent had no hair loss in the study conducted at UCSF, using the DigniCap, which gained FDA approval in late 2015 and is currently the only FDA cleared cooling system for the scalp. Those who did not use the treatment suffered loss of most or all of their hair. The DigniCap can be found in about 50 different medical centers across the United States. The second study at Baylor evaluated the Paxman Scalp Cooling System, not yet FDA approved. Again, 50 percent of the treated women retained over 50 percent of their hair. In both studies it was recognized that the treatment is less effective when the drug anthracycline is a part of the chemotherapy treatment. Patients with blood cancers may not be appropriate candidates for the treatment which is targeted to patients with solid tumors.
Cold cap treatment is not yet widely available in the United States and not currently covered by most insurance companies. Treatment is costly, at an estimated $2,000 a patient on average, but the FDA approval is a step in the right direction and researchers are optimistic that coverage may happen in the near future. One nonprofit organization called HairToStay provides scalp cooling options to patients who can’t afford treatment. Scalp cooling treatments have shown promising results in retaining hair in early stage cancer patients and may be effective for later stage patients as well. Moreover, scalp-cooling technology can potentially encourage patients who decline chemotherapy treatment due to the hair loss side effect to undergo life-saving treatment.
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