Women receiving chemotherapy for breast cancer are more likely to keep most of their hair with the help of devices that cool the scalp, according to two new studies.
The devices work like refrigerators by sending fluid into a special helmet to cool the scalp before, during and after chemotherapy treatments. Cooling likely protects the hair by constricting blood vessels in the scalp and reducing chemical activity.
"I think it's a very exciting tool, because hair loss is such a horrible manifestation of chemotherapy," said Dr. Harold Burstein, a breast cancer specialist at Dana-Farber Cancer Institute and an associate professor at Harvard Medical School in Boston.
"Whether you're a mom with young children, a teacher in a classroom or a corporate lawyer, the visible part of the chemo experience has really been that hair loss," he told Reuters Health.
Cooling caps are relatively new to the United States but are established in other countries, according to one of the new studies published in JAMA.
Barriers to their use in the U.S. included a lack of approval from the Food and Drug Administration and questions about their safety and effectiveness.
For the new studies, one team of researchers led by Dr. Hope Rugo of the University of California, San Francisco Helen Diller Family Comprehensive Cancer Center and another team led by Dr. Julie Nangia of the Baylor College of Medicine in Houston tested the effectiveness of two different cooling caps.
Rugo's team tested a device known as DigniCap on 122 women being treated for stage one or two breast cancer at five medical centers.
The women wore the cap for 30 minutes before their chemotherapy treatment, during the treatment and for 90 to 120 minutes after it ended. Scalp temperature was maintained at 3 degrees Celsius (37 degrees Fahrenheit) during treatment.
Pictures were taken of participants' scalps and hair over the course of their treatments. The women measured their hair loss based on those pictures.
Four weeks after their last chemotherapy treatment, about 66 percent of the women estimated they'd lost less than half of their hair.
The study's results also suggest women using the cooling caps had better quality of life. A handful of women using the cap reported mild headaches and only three dropped out due to feeling cold.
Nangia's team reported on 142 women at seven medical centers who were randomly assigned to the Orbis Paxman Hair Loss Prevention System or no scalp cooling while receiving chemotherapy for stage one or two breast cancer.
As in Rugo's study, the scalp cooling device was worn before, during and after treatment. Hair loss was assessed by a healthcare worker.
After four chemotherapy treatments, about 51 percent of women using the cooling device still retained at least half their hair, compared to none of the women who hadn't used a cooling cap.
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. About 16 percent of women receiving that type of chemotherapy while using cooling caps kept at least half of their hair.
Nangia told Reuters Health that differences in results at the different medical centers were likely due to improper fitting of the caps to participants' heads. Cap placement got better as the study progressed, however.
Also, she cautioned, there will always be some hair loss even with the cooling caps.
"I would say that most women would have some thinning of up to 30 percent of their hair," said Nangia.
Rugo said women receiving chemotherapy for breast cancer can inquire about cooling caps, but only one device - the DigniCap - is cleared by the FDA to be marketed in the U.S.
"I think the biggest issue for patients is the cost and the fact that you are cold," she told Reuters Health.
"Depending on the location and number of treatments, DigniCap typically costs between $1500 to $3000 per patient and is not covered by insurance," said Rugo.
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