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Cold Caps for Chemotherapy

Posted 4/14/2016

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  You may be familiar with cold caps that are advertised to prevent hair loss for women who are receiving chemotherapy. This is not an entirely new idea. Maybe twenty years ago, a different company had a similar product that was short-lived. It was expensive, very uncomfortable, and didn't work.

  This is an excellent summary from a colleague, Leora Kraus, who wrote this to share with her colleagues:

Chemotherapy Induced Alopecia and the Use of "cold caps" to Prevent Hair Loss

All systems work using the process of vasoconstriction, limiting the amount of chemotherapy that reaches hair follicles. Trials in Europe have shown the cold caps do not seem to impact the efficacy of chemotherapy treating solid tumor cancers. Most manufacturers of cold caps do not recommend them for patients with lymphomas, leukemias and melanomas. Oncologists should discuss the process with their patients as there can be concerns about scalp metastases.

Success using the caps varies. It will really depend on the type of chemotherapy, it's duration and  especially the patient's commitment and strict adherence to the use of the product.

The basic product is a gel filled cap which looks like a soft helmet and  which must be chilled to -30 degrees. There are several velcro straps and adjustments to assure a tight fit and contact with the entire scalp. It's best to begin freezing these caps the night before treatment. A frozen cap will be needed about  every 25 min so  caps (?6-8)  must kept in a cooler of dry ice not far from patient. Wetting the hair helps with the cold transfer. You must have an assistant to help quickly retrieve and tightly fit you at each cap change.
The first cap should go on about 30 min before chemotherapy administration and caps should continue to be rotated on for several hours post treatment per some manufacturers.

Yes... patients report wearing three pounds of dry ice on their heads hurts. Descriptions of "an ice cream headache" are common. Body temp may lower requiring extra clothes/blankets. Other obstacles to use may be: cost and having an "assistant". (In some larger cities patients can hire a "capper" to assist them bringing the heavy cooler to the clinic and rapidly replacing and fitting caps during treatments).
Currently, personal cold cap technology is not FDA approved and insurance will not cover it. Anecdotally,  there are some stories of insurance allowing their wig allowance to be used towards the cost of cold caps, however the cold caps products are quite expensive.
  (The commercial, computerized equipment, Dignicap WAS FDA approved  12/2015 and uses a  large machine to send a flow of cold liquid into a cap. About 10 cancer centers appear to have  or rent these in the US. Cost to pt starts at $300 per treatment and is not covered by insurance. Staff need to operate the equipment)

The two most established companies  are Penguin Cold Caps and Arctic Cold Caps. Patients should consider what's included in their prices: who supplies  the cooler, and  various  items, in addition to the caps, that are needed for best results. Monthly rental for 6 or 8 caps is between $450 and $650 a month and usually there is a month's security deposit upfront. Dry ice and a cooler capable of keeping all the caps at -30 is necessary. An infared thermometer, a timer, a sprayer bottle for water, extra straps or headbands for a better fit and gloves are  helpful and may or may not be included in the monthly rental.
Elasto Gel is a company that has started selling individual caps for about $85 each.

Success rates for any of these vary. Patients must be highly motivated. It also helps if they are doing other things to prevent hair loss such as treating hair gently, using a satin pillowcase, infrequent shampooing or using dry shampoo etc.  Also success is a relative term. Some patients are very pleased with these products if the end result is only significant thinning but not total hair loss. I would encourage patients to watch the videos the manufacturers have on line, read the reviews and speak to patients who've actually tried these systems.


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