Quackery or Quacking Good?

In this order:  1) Lose the cancer.  2)  Keep the hair.

Easy, right?  No, but it’s possible, with some work, discomfort, cost, and luck.  My oncologist is responsible for part one.  Treating the cancer is the clear goal, period.  However, if there’s a way for me to hold onto my hair, assuage my vanity, and significantly improve my quality of life without affecting the therapeutic benefit of the chemo, why not?  My job therefore is to take charge of part two.

Cold caps, more commonly constructed from gel-filled ice pack material, have been used with increasing success and convenience for a couple of decades around the world.  Their acceptance has only recently made inroads in the US, gaining in popularity through word-of-mouth as breast cancer patients share the hopeful news with their sisters in disease.  They are believed to function via vasoconstriction: the freezing cold (-30F) caps slow blood flow to to the scalp, in turn curbing chemo uptake by hair follicles.

The dominant version in the US, the Penguin Cold Cap, requires a patient’s helper to precool caps in a special freezer or dry ice filled cooler.  At the infusion clinic, the helper straps a new cold cap securely around the patient’s scalp before, during, and after chemo treatment every 20-35 minutes.  Here are some views from the Penguin webpage.

A worry which logically follows is whether limiting chemo in the scalp leads to an increased risk of scalp metastasis.  For my very early node-negative stage of breast cancer, the miniscule risk is the same with or without cold caps. Scalp cooling is contraindicated, however, for cancer patients with more extensive disease and in particular for patients with blood borne cancers like leukemia.  Another reasonable concern would be whether scalp cooling reduces the therapeutic flow to the brain; fortunately cold caps do not appear to result in a statistically significantly higher incidence of brain metastasis, perhaps because scalp cooling inflicts an insufficient drop in brain temperature.

Cold caps do not work equally well in preventing alopecia from all chemo drugs nor in all patients.  Hair retention has been particularly noteworthy for patients with lower dosage taxane therapy when not combined with adriamycin and cyclophosphamide (AC-T), which is good news for my own low dose Taxol-Herceptin regimen.

Penguin Cold Caps are not the only available cold cap therapy.  UCSF is running a cold cap trial testing out a newer implementation of scalp cooling.  Instead of ice pack hats that need to be precooled in a freezer or cooler and changed periodically, DigniCaps are permanently attached to a portable air conditioner sized device for on-the-spot cooling.  This is an image of the headgear portion of the DigniCap, as excerpted from the manufacturer’s website.

 The outer cap

The upshot:  come chemo time, you’ll probably find me under a blanket shivering due to the frigidity of a Penguin Cold Cap, but hopefully with a head still covered by (my own) hair. Quack, quack.


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