Keeping a Cool Head On Cold Cap

I wish more oncologists would tell their patients about this incredibly simple Hair saving technique, but unfortunately many are either unaware of how effective it is or are uniformed believing it might cause you harm.  Hair loss is a distressing and common side effect of Chemotherapy that can be reduced by scalp cooling. For over 15 years (mainly in Europe), patients have been using scalp “cold cap therapy” (CCT or scalp cooling) to keep their hair from falling out during chemotherapy. Recent studies have indicated that cold cap therapy can prevent hair loss in up to 90% of those using it during chemotherapy.

Now the Food and Drug Administration (FDA) has cleared the first such device for marketing in the United States. The DigniCap Cooling System has undergone a pivotal trial conducted at several centers in the US, and has been cleared for use to reduce hair loss in patients undergoing chemotherapy.

Managing the side effects of chemotherapy is a critical component to overall health and recovery.
Hair loss is a big deal for many patients. For many women, this is the most emotionally distressing and disturbing impact from their diagnosis. Some women even think about skipping the chemotherapy because it will adversely affect them at work when they lose their hair.

Cold caps — tightly fitting, strap-on hats filled with gel that’s chilled to between -15 to -40 degrees Fahrenheit — may help some women keep some or quite a bit of their hair during chemotherapy. Because the caps are so cold, they narrow the blood vessels beneath the skin of the scalp, reducing the amount of chemotherapy medicine that reaches the hair follicles. With less chemotherapy medicine in the follicles, the hair may be less likely to fall out.

During each chemotherapy session, you wear the caps for:

• 20 to 50 minutes before
• during
• after

each chemotherapy session (the amount of time you wear the cap after the chemotherapy session depends on the type of chemotherapy you’re getting)

There are several brands of cold caps. Penguin Cold Caps, Chemo Cold Caps, and ElastoGels are chilled with dry ice in your own cooler or in a special freezer at the chemotherapy treatment center (the freezer in your house can’t get the cap as cold as it needs to be). Penguin Cold Caps and Chemo Cold Caps rent out caps for the length of your chemotherapy treatment.

You may have to change the Penguin, Chemo, and ElastoGel caps several times during the chemotherapy treatment. Each cap is usually worn for about 30 minutes; then it warms up and is replaced with a new cap.

DigniCap is a computer-controlled system that circulates cooled liquid to a cap worn on the head during chemotherapy treatment. The cooling cap is covered by a second cap made from neoprene, which fastens under the chin and holds the cooling cap in place. It also acts as an insulation cover to prevent loss of cooling.
The cooling action is intended to constrict blood vessels in the scalp, which, in theory, reduces the amount of chemotherapy that reaches cells in the hair follicles. The cold also decreases the activity of the hair follicles, which slows down cell division and makes them less affected by chemotherapy. The combined actions are thought to reduce the effect chemotherapy has on the cells, which may reduce hair loss, the agency explains.

The efficacy of the device was studied in 122 women with stage 1 and stage 2 breast cancer who were undergoing chemotherapy, using recognized chemotherapy regimens that have been associated with hair loss. The data from this study may also be applied to some stage 3 and stage 4 breast cancer patients because they may have a benefit-risk profile comparable to that of the patients enrolled in this study.

Hair loss is so much greater than vanity. It is linked to a woman’s sense of well-being, self-esteem, sense of control, and privacy. Some are women who want to keep working through their treatment, others are mothers who do not want their children to know they are undergoing treatment.

It would likely work in patients with other solid tumors that are being treated with the same chemotherapy regimens, but the use of the DigniCap is not recommended for use in patients with hematological malignancies. The cooling of the scalp reduces the amount of chemotherapy reaching the scalps, and while this poses a minimum risk for patients with solid tumors, for blood cancers this risk is greater, she explained.

The FDA said in the approval notice for DigniCap that prevention of hair loss in these patients may be a significant benefit to their quality of life, and the risk of the chemotherapy drug missing an isolated grouping of the breast cancer cells in the scalp.

The most common side effects of the cooling system include cold-induced headaches and neck and shoulder discomfort, chills, and pain associated with wearing the cooling cap for an extended period of time.
The DigniCap Scalp Cooling System and Paxman Scalp Cooling System caps connect to a cooling/control unit that then chills the cap to the proper temperature. Since the DigniCap and Paxman systems are chilled by the control unit, you don’t have to change caps during treatment.

Because the caps are so cold, some women get a headache while wearing the cap. Most women get very cold, so it makes sense to dress warmly and bring warm blankets with you if you decide to try the cold caps.

Women who use cold caps during chemotherapy are advised to baby their hair during treatment:

• no blow drying, hot rollers, or straightening irons
• shampoo only every third day with cool water and a gentle shampoo
• no colouring until 3 months after chemotherapy is done
• gentle combing and brushing

The cost of using the caps varies depending on the manufacturer, the number of chemotherapy sessions you’ll be having, and the number of months you’ll be using the caps. Some users have said the cost of the caps is comparable to the cost of a having a wig made. Check with your insurance carrier to see if the cost of renting the caps is covered.

Chemo Cold Caps does not recommend scalp cooling for anyone who has already begun one or more chemotherapy infusions. It is also generally recommended that scalp cooling should not be used with the following cancers: leukemia, multiple myeloma, lymphomas, and melanoma. Also, patients with the following conditions may not tolerate scalp cooling well: cold sensitivity, cold agglutinin disease, cryoglobulinemia, cryofibrinogenemia and cold traumatic dystrophy.

We sincerely wish you all the best and to get well soon.

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