Daily Dose

Can wearing a cold cap prevent hair loss from chemotherapy?

Several news reports this week have highlighted the supposed benefits of placing a cold cap on the scalp to prevent hair loss from chemotherapy. While these reports have emphasized the experimental nature of the device—it hasn’t yet been approved by the US Food and Drug Administration—some women have been using them on their own.

A handful of breast cancer patients at Dana-Farber Cancer Institute have rented these caps from a British company for about $450 a month – they’re not covered by insurance—packing them on dry ice to bring to their chemo sessions. The caps need to be replaced every half-hour or so when one loses its chill.

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“We occasionally have patients who use them,” said Dr. Erica Mayer, a medical oncologist at Dana-Farber’s breast oncology center. “But they need to bring a freezer and someone to help them change the caps.” Nurses aren’t allowed to assist.

Do the caps actually prevent hair loss?

Researchers in California and North Carolina are conducting a small study involving 110 patients with early-stage breast cancer to get a better sense of the device’s effectiveness and to enable the American-based cap manufacturer to apply for FDA approval.

The few patients who have used them at Dana-Farber have had mixed results; some have very little hair loss, according to Mayer, while others experience significant bald patches. Most have some hair thinning even if they don’t lose all their hair.

“It looks like they have less hair loss with the caps, but they’re not a guarantee against significant hair loss,” Mayer said.

Some patients experience headaches or “brain freeze” from the chilled cap. Getting the scalp to a frigid temperature is necessary to shrink blood vessels. The idea is that this prevents chemotherapy agents from getting to hair follicles and destroying them.

Oncologists, though, worry that the cap may have one major detriment: increasing the risk of a cancer recurrence in the scalp because of a lack of treatment to that area.

“It’s really a theoretical risk,” Mayer said, “since we rarely have patients who develop a recurrence in their scalp.”

Mayer said she’s discouraging patients from using cold caps until study results can document that they work with no added cancer risk. But she said she also understands those patients who opt to use the caps on their own.

“If I have a patient who feels strongly about using cold caps and is reluctant to go through chemotherapy without them, I think it’s reasonable to support her decision,” she said.

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