A bald head—one of the most visible and devastating side effects of cancer treatment—may not be inevitable, thanks to an amazingly simple treatment called scalp cooling that uses extreme cold to protect hair follicles from chemotherapy. So far, more than 1,000 American women have tried the still experimental treatment with high success rates.
More than 24 US cancer centers have now installed special freezers for helmet-like cooling caps to help patients undergoing chemotherapy save their hair. Filled with silicone gel frozen to minus 22 degrees Fahrenheit, cold caps reduce blood flow to the scalp during chemotherapy. As a result, hair follicles are zapped with much lower amounts of toxic chemicals and patients are less likely to shed their tresses.
While early clinical trials of scalp cooling had disappointing results, a review of 53 studies of scalp cooling that have been conducted since 1995 found a median success rate of 76 percent if the scalp was cooled for 90 minutes after the chemotherapy infusion.
In another recent study, researchers reported success rates ranging from 77 percent to 100 percent, depending on which type of chemotherapy was used. Other studies have reported effectiveness ranging from 46 to 100 percent, according to a 2011 review of 83 studies
While scalp cooling is widely used overseas, it’s not FDA approved. And many oncologists have been skeptical about its safety, fearing that reducing the amount of cancer medication that reached the scalp would put cancer patients who used cold caps at risk for disease spread in the treated areas.
However, a review of 83 studies presented at the 12th International Conference of Early Breast Cancer last year found that of 1593 patients treated with cooling caps, only 10 developed scalp metastases, all of whom also had cancer spread to other areas of body. The most common side effects of scalp cooling were headache, ear pain, and feeling cold.
Until recently, the hair-saving treatment was only offered in clinical trials in the US. Now a scalp cooling system called Penguin Cold Cap Therapy is available for $500 a month. About 50,000 patients worldwide have reportedly used it, with more than 80 percent success, according to the manufacturer.
The caps are frozen in special freezers to -22º F—or in coolers on dry ice--then worn for at least an hour before the chemo session to chill the scalp to about 40 degrees before exposure to the chemicals.
Patients continue wearing the cap during treatment and four hours afterwards. Up to 14 Penguin caps are used per treatment. As one cap warms up, it must be swapped with a frozen one within about a minute. Experts recommend having a friend practice making the switch as quickly as possible, so that the patient’s scalp stays chilled during the entire treatment.
Particularly for women, hair loss during chemo can often trigger depression along with loss of self-confidence and even hope. Cancer doctors have told me about female patients who delay or even refuse chemo due to fear of hair loss, or insist on less effective treatments to avoid having their cancer diagnosis become visible to employers and friends.
“It’s torture for the women,” Dr. Hope Rugo, UCSF director of breast oncology told MSNBC. “Patients will say to me, ‘I know this sounds stupid, it seems so much like my vanity, but the thing I’m most worried about is losing my hair.” Dr. Rugo launched a clinical trial of scalp cooling after a patient with late-stage cancer said she’d rather die than live an extra year bald from chemotherapy.
When 50-year-old dance choreographer Peggy Hickey was diagnosed with stage 2 breast cancer last year, she particularly dreaded the prospect of losing her long, wavy mane. “That would be really devastating,” she told the The Daily News. “My hair is part of my personality, it's who I am."
Then her daughter read about Penguin Cold Caps. When Hickey’s doctor dismissed the idea, saying he didn’t believe scalp cooling worked and it might interfere with treatments, she enlisted the help of actress Christina Applegate to find an oncologist willing to try hair chilling during her chemotherapy.
During treatment, the caps were painfully cold for a few minutes. “And then your head numbs up and it’s better,” says Hickey, whose signature tresses remained intact throughout her chemo, with only slight shedding. "No, it's not curing cancer, but it sure is helping women deal with cancer better,” she says of scalp cooling.
Another cancer survivor, Nancy Marshall, was so impressed by her experience with the cooling caps that she co-founded The Rapunzel Project, a nonprofit support group that helps cancer patients keep their hair. However, cold caps aren’t an option for every chemo patient and the cost isn’t normally covered by insurance.
One of The Rapunzel Project’s top priorities is to equip hospitals with freezers for storing Penguin Cold Caps. Each cap needs its own storage box in special, super-cold freezers, which only have room for 28 cold-cap boxes—enough for two chemo sessions per day.
So far, Rapunzel Project has placed about 20 freezers in cancers centers nationwide, but many more are needed. “We want people to know you don’t have to lose your hair to have chemo,” Marshall says.
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