Cold Caps May Reduce Hair Loss

Hester Hill Schnipper, LICSW, OSW-C Program Manager Emeritus, Oncology Social Work

MARCH 06, 2019

Antidote for a Dreaded Cancer Treatment Side Effect

As we all know, some chemotherapy drugs cause hair loss. There is a range in their impact, everything from guaranteed baldness between 14 and 21 days after the first infusion to ongoing thinning with an uncertain outcome of how much hair will eventually return. Personally, I have had both experiences, one in 1993 and one in 2005, and would be hard pressed to choose which one was more difficult.

Absolute hair loss, although dreaded and hated by everyone, is at least predictable. You know what is going to happen, and you have some choices about how to prepare. In 2005, this was my experience as one of the drugs that I received, Adriamycin, was certain to have this effect. I chose to take control as I could and had my head shaved two weeks after the first infusion. This was terrible, but, for me, less traumatic than living though a few days of rapid and absolute hair loss. In 1993, the standard care for breast cancer used different drugs, CMF, and they resulted in thinning throughout the six months of treatment. Some women ended up bald, some lost only a little hair, and most were somewhere in between. The “in between” was my outcome, and the constant hair loss, often looking as though there had been a cult ritual in the shower or bathroom, was very hard. By the conclusion of chemotherapy, I usually chose to cover my head, but there was still some hair there.

Over the last few years, cold caps have been introduced with the goal of reducing hair loss. Note that they do not work for all drugs, and they rarely achieve the lofty goal of protecting a full head of hair. When they work, the situation is more like the lesser hair loss described above: hair thins, and you can’t know exactly how much will eventually be lost.

How do they work? The theory is that the cooling narrows the blood vessels in the scalp so less drug reaches the hair follicles.Some doctors, in some situations, have concerns about this, so it is important to have a discussion regarding the safety of this attempt for you and your cancer. Most of the studies have been done with women receiving chemotherapy for breast cancer, and the caps worked much better if they were receiving Taxol and not so well if the drug was Adriamycin. At this time, the caps are approved for most cancers, except for leukemia or other blood cancers.

The overall success rate is about 50%-80%. This indicates that scalp cooling, or cold caps, does not completely stop hair loss.However, a patient may have 50%-80% less hair loss than she would without this system. Again, the efficacy depends on the specific drug and the dose that you are receiving.

What is involved? Woman who want to try to preserve their hair with cold caps need to use the caps for at least 30 minutes prior to and 90 minutes after the conclusion of the infusion. There are two main companies: Dignicap and Paxman. The newest systems involve a computerized system that keeps a coolant running through the caps for the duration; this is definitely an improvement over earlier models that required freezing the caps on dry ice and replacing them every 20-30 minutes. However, this system does require that your infusion center can provide the equipment. If they can't, the earlier strategy of using multiple frozen caps can be under your control.

At BIDMC, we support women who want to try one of these systems. Speak with your doctor and your chemo/infusion nurse before beginning treatment. Do remember the pitfalls. In addition to the fact that these caps don’t always work, some women find them intolerably cold and don’t continue the use. As long as your doctor has approved the use in your particular situation, there are no other problems. Except, of course, for cost. Both systems are quite expensive, and insurance does not cover the cost. There are a couple of patient advocacy groups that may offer assistance: HairtoStay and The Repunzel Project.

If you are facing chemotherapy that will cause hair loss, and you want to try to preserve your hair through scalp cooling, you need to begin with the first infusion. Remember that it may help you keep your hair ... or ... that it may not work so well. Once again, we have an example of the uncertainties of cancer care.

Have you tried a scalp cooling system? Share your story in the BIDMC Cancer Community.