Cooling caps help cancer patients keep hair during chemotherapy

Losing one's hair because of cancer treatment is an unwelcome side effect patients fear, but now the staff at Exeter Hospital may have a solution to offer - cooling caps.

"When a patient is diagnosed, the first thing they think about is chemo and how awful the side effects are," said Shannon Marcus, RN, who works at Exeter Hospital's Center for Cancer Care. "They have seen images, heard terrible stories. Cancer treatment has come a long way, but this is one area where change has been slow. The idea of hair loss is met with trepidation. But they shouldn't defer or delay treatment that could save their life."

Cooling caps have been used for several years now, but Exeter Hospital staff believe they are the only ones currently bringing the treatment to the Seacoast .

Eileen McDonald, senior director of the Center for Cancer Care, said Dr. YongLi Ji, a medical oncologist at Exeter Hospital's Center for Cancer Care, which is affiliated with Massachusetts General Hospital, saw the impact of the caps there and lobbied to bring them to the Seacoast.

"She has been working on getting them here for a couple of years," said McDonald. "Because of COVID, this got stalled for a while, but she recently brought it up again and we went for it."

"I think it's wonderful we can bring this here," said Ji. "I am sure our patients will love it. It works by keeping the amount of chemo that reaches the scalp to a minimum. It protects the scalp and the hair follicles from strong chemo."

How hair loss affects cancer patients

McDonald said for some patients, losing their hair immediately outs them as having cancer, something they may not be ready to share with family, friends or work colleagues. She said some people may choose to forego life-saving chemo treatments over the fear of hair loss, which they consider the worst side effect of treatment.

"For some, cancer is a private thing," said Ji. "In many cases, women want to protect their children from the worry for as long as they can. They worry about how they will be treated at work. There are many legitimate reasons to fear hair loss and this is a chance to help."

"Helping them keep hair helps increase self-esteem," said Ji. "Well, at least they keep some hair for their head. It will not help with eyebrows or eyelashes."

Marcus, who has worked with a hospital where the caps were used, said the first day of chemo is nerve-wracking, so if the caps can help remove one worry, then treatment can be more positive.

"Hair loss is 75% the most feared side effect of chemo," said Marcus. "It is not a 100% guarantee. When it works, it is empowering. We had one patient who went in for a follow-up appointment with her oncologist, who was amazed by her full head of black hair. No one could tell she had cancer. She kept working and no one knew."

Ji said the cooling cap is FDA-approved for use with breast cancer, ovarian cancer, fallopian tube cancer and primary peritoneal cancer. It is not approved for blood cancers like leukemia and lymphoma.

Exeter Hospital is using the Paxman cooling cap system, which originated in the UK and has US corporate offices in Houston, Texas.

Why does chemotherapy make hair fall out?

"Chemotherapy works by targeting all rapidly dividing cells, and hair cells are the second-fastest-dividing cells in the body, which is why many chemotherapy drugs cause hair loss," according to information provided by Paxman. "Vulnerable hair follicles in the growth phase are attacked, resulting in rapid and extensive hair loss approximately two weeks after the start of chemotherapy." 

How does scalp cooling prevent hair loss?

Scalp cooling technology can alleviate the damage caused to the hair follicles by chemotherapy by reducing the temperature of the scalp by a few degrees before, during, and after chemotherapy treatment, according to Paxman. Cooling causes blood vessels to constrict reducing blood flow and the amount of chemotherapy ingredients that reach the hair follicles. Paxman says the treatment is safe and the most common side effect is a minor headache caused by the cooling. 

Paxman's website said scalp cooling has a success rate of up to 70% for some chemotherapy regimens. While it is not as successful with other regimens, there is evidence scalp cooling encourages faster, healthier and stronger regrowth than would occur without scalp cooling, according to Paxman. 

Will insurance cover scalp cooling?

Most health insurance will not cover the cost of the cooling cap treatments. McDonald said there are some national and International funds available to help. The cost for the cap averages about $1,500 to $3,000.

"Our Beyond the Rainbow fund at EH might be able to help with the cost," said McDonald. "Patients can donate the caps back to the program when they complete treatment if they want to. They would be cleaned and returned to use."

"Chemo does not need to be the scary treatment of the past," Marcus said. "There are a host of medications now that help with the side effects. This can be one more."