Prevent Hair Loss During Chemo: Cold Caps Are Being Tested

Cold caps are being tested on patients going through chemotherapy in hopes that it will prevent hair loss.

The first time Miriam Lipton had breast cancer, her thick locks fell out two weeks after starting chemotherapy. The second time breast cancer struck, Lipton gave her scalp a deep chill and kept much of her hair — making her fight for survival seem a bit easier.

Hair loss is one of chemotherapy’s most despised side effects, not because of vanity but because it fuels stigma, revealing to the world an illness that many would rather keep private.

“I didn’t necessarily want to walk around the grocery store answering questions about my cancer,” recalled Lipton, 45, of San Francisco. “If you look OK on the outside, it can help you feel, ‘OK, this is manageable, I can get through this.’”

Now U.S. researchers are about to put an experimental hair-preserving treatment to a rigorous test: To see if strapping on a cap so cold it numbs the scalp during chemo, like Lipton did, really works well enough to be used widely in this country, as it is in Europe and Canada.

Near-freezing temperatures are supposed to reduce blood flow in the scalp, making it harder for cancer-fighting drugs to reach and harm hair follicles. But while several types of cold caps are sold around the world, the Food and Drug Administration hasn’t approved their use in the US.

To Dr. Hope Rugo of the University of California, San Francisco, the impact of hair loss has been overlooked, even belittled, by health providers. She’s had patients delay crucial treatment to avoid it, and others whose businesses suffered when clients saw they were sick and shied away.

Later this summer, Rugo and Melin, along with researchers at a few other hospitals in New York and California, will begin enrolling 110 early stage breast cancer patients in a study of the DigniCap brand of scalp cooling. The tight-fitting, insulated cap is attached to a cooling machine to stay around a shivery 41 degrees as patients undergo chemo. Participants’ hair will be photographed for experts to assess, and they’ll be compared with a small group of similarly ill patients who get chemo alone.

Patients haul a collection of caps to chemo sessions on dry ice, or store them in special freezers provided by about 50 hospitals. It’s deliberately separate from doctors’ and nurses’ care — typically, patients bring a friend to help them switch caps every 20 to 30 minutes when one loses its chill.

“I know I’m sick, but I don’t want to look it,” said Vanessa Thomas, 57, of Baltimore, who is using the Penguin caps at the recommendation of her doctor at MedStar Harbor Hospital. Halfway through her breast cancer treatment, Thomas says her hair feels only a little thinner.

Hair-preserving approaches need good testing, adds Dr. Laura Esserman, a UCSF breast cancer specialist.

“If it matters to our patients, it should matter to us,” she said. “It’s really not more complicated than that.”