“This is such an important aspect of
patient well-being and healing,” says
Nancy Marshall, co-founder of the
Rapunzel Project, a nonprofit that educates patients about cooling cap options.
Caps that could be manually frozen,
either with dry ice or in biomedical
freezers, like the Arctic Cold Cap and
Penguin Cold Cap, were among the first
products used to keep the head cool to
prevent hair loss during chemotherapy.
Now, there are two cooling machines
that the U.S. Food and Drug Administration
(FDA) has cleared for distribution to
patients with any type of solid tumor:
the DigniCap Scalp Cooling System
and the Paxman Cooling Cap. Because
these caps have been cleared by the
FDA, insurers are more likely to cover
them. Marshall says FDA clearance also
increases the likelihood that doctors
will recommend them.
Cooling caps are thought to work
by constricting the blood vessels in
the scalp. This reduces the amount of
chemotherapy drugs that gets to the hair
follicles and the hair cells. Clinical trials
for the Paxman and DigniCap systems
found that 50 to 66 percent of breast
cancer patients in the group that used a
cooling cap kept most of their hair, while
100 percent of patients who did not use a
cap lost all or most of their hair.
All of the caps work better with some
types of chemotherapy than others,
says Julie Nangia, an oncologist at the
Baylor College of Medicine in Houston.
Patients on taxane drugs, like Taxol
(paclitaxel) and Taxotere (docetaxel),
for example, generally keep more hair
than patients being treated with an
anthracycline, such as Adriamycin
(doxorubicin) or Ellence (epirubicin).
Cooling may also help with other
treatment-related side effects. A
Japanese research team reported
in the February 2018 Journal of
the National Cancer Institute that
fitting patients with frozen socks and
mittens during treatments prevented
pain, tingling or numbness in the hands
Dawn Hershman, an oncologist at the
Herbert Irving Comprehensive Cancer
Center at Columbia University in New
York City, who wrote an editorial pub-
lished along with the study, says she
was “surprised” that cooling helped
reduce neuropathy. “I don’t know that
anybody understands what the mecha-
nism for that would be,” she says.
Hershman says that although more
research is needed, she finds the results
encouraging. “This doesn’t have a lot of
side effects, is not horribly expensive
and is only administered during, before
and after the infusion,” she says. “It
could be very helpful.” —DELIA O’HARA
COLD TREATMENTS MAY HELP SOME PATIENTS
AVOID HAIR LOSS, NEUROPATHY
Hair loss has long been a distressing and well-recognized side effect of chemotherapy. Now, fitted cooling caps worn before, during and after chemotherapy sessions are
helping some patients keep their hair and skip the wigs and head
coverings they might otherwise have used.
About 25 percent of breast cancer patients receiving weekly Taxol (paclitaxel) develop
peripheral neuropathy (tingling in the hands and feet) that may require them to delay,
reduce or stop treatment. This study confirmed that blood tests that measure levels of
Taxol after the initial treatment can predict which patients are at high risk for neuropathy.
The researchers suggest prospective studies be conducted to see if using the test results
to manage patient care can reduce treatment-limiting neuropathy.
LEARN MORE IN THE ONLINE FIRS T APRIL 27, 2018, CLINICAL CANCER RESEARCH.
Predicting Treatment-Limiting Neuropathy in Breast Cancer Patients
Cooling caps vary in price, and some require
security deposits or have shipping costs. These
are four of the available options. Check with
your insurer to see what they may cover.
• Arctic Cold Cap: $379 per month and up.
• Penguin Cold Cap: $495 per month.
• DigniCap: $275 to $350 per treatment.
• Paxman Cap Kit: $800 for the first four
treatments, plus $500 for the cap.
HairToStay ( hairtostay.org) gives subsidies
to eligible patients to help offset the cost of
Cold Capital Fund ( coldcapitalfund.org)
provides assistance to cancer patients in
Maryland, Virginia and Washington, D.C.
The Rapunzel Project ( rapunzelproject.org)
offers information about preventing hair loss
and a list of which cancer centers have which
caps and how to locate them.
THE COST OF COOLING