Preventing Hair Loss From Chemotherapy

For many women, one of the first and scariest thoughts when diagnosed with breast cancer is not about the loss of their breast, but about losing their hair. A 2010 survey found that nearly half of breast cancer patients feel that hair loss is the most traumatic side effect of chemotherapy, with some experiencing less distress over losing their breast than their hair. And 8 percent of the women polled would choose to forego chemotherapy because it meant losing their hair. It's not hard to understand why hair loss can be so emotionally devastating. For many women, hair is an important part of their identity and sexuality, and losing it diminishes their sense of self. Hair loss can also take away your privacy – since it's such a very visible and constant reminder that you're sick with cancer. Unfortunately, until recently, most American women did not know about nor have access to a treatment that helps prevent chemotherapy-induced hair loss. Cold caps have been used in Europe for more than 40 years, and in 2015, a newer scalp cooling technology, called DigniCap, was Food and Drug Administration-cleared for use in the U.S. Two studies published recently in the Journal of the American Medical Association found that approximately half the women who used this scalp cooling device were able to keep more than 50 percent of their hair while undergoing chemotherapy. The news was even better for women receiving taxane-based chemotherapy (Taxol, Taxotere and Abraxane), with two-thirds of women able to preserve more than half their hair. According to hair experts, that 50-percent mark is important because hair loss isn't noticeable to other people until more than half of it is lost.

How Scalp Cooling Prevents Hair Loss

The hair-making cells, called hair follicles, are very sensitive to chemotherapy. Cold caps and scalp cooling systems keep the scalp cold, which narrows the blood vessels, reducing the amount of the chemotherapy medicine that reaches the hair follicles. It also decreases the activity of the hair follicles, slowing down cell division and making the follicles less affected by the chemo treatment. To be effective, cold caps need to be worn for a period of time before, during and after a chemotherapy treatment. It's also important for a cap to be tightly fitted to ensure it's coming in contact with the entire scalp.

Weighing Your Options

There are two different types of devices used for preventing hair loss: cold caps and scalp cooling systems. Cold caps are similar to ice packs and are kept in a special refrigerator before they're used. Because they thaw during a chemotherapy session, they have to be replaced with a new cap every half hour. It's difficult to change the caps on your own while having an infusion, so another person is usually needed to help with the process. Both the caps and fridges are usually rented by the patient. The cost depends on the number of chemotherapy sessions needed and how many months of treatment is involved. A typical cost for these caps is about $500 per month. Depending on your insurance plan, the cost of renting the cap may be covered. There are also charitable programs that provide financial assistance to women who can't afford to pay for a cold cap. Scalp cooling systems are a newer computer-controlled cap device attached to a small refrigeration machine that circulates coolant throughout the chemotherapy session, eliminating the need to change caps during the treatment. As mentioned earlier, DigniCap has been FDA cleared; another, the Orbis Paxman System, is pending FDA clearance. These systems are owned by a limited number of cancer treatment centers around the country and offered at a cost to patients receiving chemotherapy. Patients are usually charged between $1,500 and $3,000, which may or may not be covered by insurance.

Results and Side Effects

The results of scalp cooling treatments vary and, for some women, they are not that effective. An important factor is the type of chemotherapy and the dosage you're taking. Studies have found that women who are given only taxane chemotherapy have far better results than those who get only anthracycline-based chemotherapy (Adriamycin, Ellience and daunorubicin). Hair type may also impact hair loss. There is some evidence that women with thicker hair may not respond as well to scalp cooling as those with thinner hair. This may be because thicker hair prevents the scalp from getting as cold as it needs to be for the treatment to be effective. It's essential that the caps be tightly fitted and cover the entire scalp. If not, hair loss can occur in the areas where the cap is not close enough to the scalp. There can also be some discomfort when using both cold caps and scalp cooling systems. Reactions can include cold-induced headaches, chills and neck and shoulder pain. Additionally, there are some concerns about the risk that the caps prevent the chemotherapy from fully killing off the cancer cells that might be in the scalp, and therefore put women at risk for a future cancer. However, many studies in Europe where it's been used for decades have not found any increased risk of cancer in the scalp after the use of the caps, and the FDA considers such cases extremely rare. If chemotherapy is part of your treatment plan and preventing hair loss is important to you, make sure to discuss the options with your physician before chemo begins. Ask about the effects that your chemo regimen and hair type might have on the results, as well as whether a scalp cooling system is available at your treatment center and their success rate in preventing hair loss. And make sure to find out whether your insurance covers any of the costs so you're not stuck having to pay unexpected bills. If hair preservation is not possible or the right choice for you, but you feel that hair is important to preserve some sense of normalcy, there are wonderfully styled wigs that are far more natural looking and comfortable than in the past. Many are available at a low cost, but high-quality human hair wigs can be pricey. Some women find scarves and turbans work best for them and can get very creative with their design, while others discover a sense of empowerment and beauty in baring their bald head.