The Paxman study was stopped earlier than planned, after four cycles of chemotherapy, because findings showed the cooling cap was highly effective at preventing hair loss. Two types of cooling caps are typically used: frozen caps that need to be replaced every half hour, or cooling systems that continually circulate coolants into a cap during the entire chemotherapy session. Cooling causes the blood vessels in the scalp to clamp down, thereby sparing the scalp of chemotherapy, but also raising the possibility that if some cancer cells were residing there, they might go untreated. The UCSF Comprehensive Cancer Center continues to use the latest research and technology to battle cancer and was recently rated 16th best cancer center in the nation by US News and World Report.
There are a few cooling caps approved by the FDA.
A group of researchers tested a device called DigniCap on 122 women that are being treated for stage one and two breast cancer at five medical centers. Before their chemotherapy treatment, these patients wear the cap for 30 minutes, during the treatment and 90-120 minutes after it ended. During treatment, the temperature of the scalp was kept at three degrees Celsius.
Pictures were taken of participants' scalps and hair over the course of their treatments. Some of its side effects include nausea and vomiting, loss of appetite, mouth soreness, fatigue and hair loss. Researchers reported that only two-thirds of the patients lost half or even less hair during chemotherapy.
Also, results showed that the women who wore cooling caps had a better quality of life than those who didn't. What the caps can do is lessen the amounts of hair lost and not stop hair loss completely.
While the cooling cap may not remove the side effects of chemotherapy, Dr. Harold Burstein said that the tool will benefit for breast cancer patients because hair loss was an uncomfortable experience, yet a visible manifestation of chemotherapy. The first study, as well as the second, received funding from the developers of these cooling devices. Hair loss was assessed by a healthcare worker.
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Of those who underwent scalp cooling, 66.3% retained half or more of their hair, said the authors, led by researchers from the University of California, San Francisco.
Unlike Rugo's study, Nangia's team included women who received anthracycline-based chemotherapy, in which hair loss is less likely to be inhibited by cooling caps. That has led to a big market for cooling caps, which are purported to limit hair loss.
"I would say that most women would have some thinning of up to 30 percent of their hair", said Nangia.
"Enabling a woman to preserve her hair during chemotherapy is empowering", said senior author Tessa Cigler, MD, MPH, an assistant professor of clinical medicine in the Weill Cornell Breast Center at Weill Cornell Medicine.
The cooling cap is now not covered by insurance and patients would likely need to pay around $1,000 to $2,000 per session, said Rugo. Patients involved in the scalp cooling study will be followed for five years to determine any adverse effects, including scalp metastases, along with recurrence and overall survival.