The Fight to Prevent Hair Loss During Chemotherapy

Psychosocial Effects of Chemo Induced Hair Loss

A woman’s hair is her crown and glory. I cannot imagine the trauma that impacts a woman’s life when she is not only diagnosed with cancer but also facing the reality of hair loss. It’s considered almost inevitable. Chemotherapy not only ravishes your body but your hair as well. It is a combination of drugs that work to kill cells that grow quickly. The issue is that chemo does not discriminate between the types of cells that it dies. The drug travels throughout the body without discernment; meaning that normal cells not affected by cancer like hair follicles and blood are also chemo targets. That is, until now. A not so recent breakthrough in cooling technology is enabling women to keep their hair while undergoing treatment for breast cancer. And it’s epic. In 2014 a survey was taken to measure the effects of hair loss on the psyche of women cancer patients. 47% of the women surveyed reported that the alopecia brought on by the chemo is the worst side effect of the treatment. And 8% of women said that they would forego the life-saving treatment to save their hair.

Cold Caps & Cooling Systems

How do you combat such intense feelings and convince women to get the treatment that will save their lives? Scalp Cooling. Scalp cooling is a practice that involves a chemo patient wearing a cap to reduce the scalp’s temperature. These scalp cooling caps snug fitting caps that resemble a helmet. There are two ways that patients are receiving the cooling treatment. One type of scalp cooling referred to as a cold cap has a gel coolant filling that’s chilled to between -15 to -40 degrees Fahrenheit. To receive these caps, you would contact a private company offering the specialized gel caps for rent in sets of 4 to 8. The patient wears the cap 20 to 50 minutes before, during, and after each chemo treatment all the while cooling it between wears with dry ice or a BioMed freezer. The second way involves a cap that is attached to a freezing machine and called a cooling system. The cooling system the better option of the two because it offers a steady cooling temperature throughout wearing it. The device itself circulates coolant to the cap which provides a stable cooling effect throughout the cap. Prior to using it, you are required to go through a fitting to secure the cap itself onto your head. Both the fitted cap and the cooling consistency of a cooling system allows you to avoid constantly changing the cap. Both scalp cooling methods use the cold temperatures to shrink the blood vessels and minimize the amount of chemo able to reach the hair follicle. This is why it is essential that the cap is fit snug to your head without any air pockets. Any pockets or bubbles in the fit may cause bald spots or missing patches of hair.

Caring For Your Hair During Chemo & Cold Cap Use

Because your hair is going through so much during chemo, when using the cold cap you are advised to treat your hair with more TLC than usual. Heat tools used for blow drying, hot rollers, or straightening irons are discouraged. It is also advised to shampoo your hair less as to avoid constant manipulation. For those of us who wash our hair every day, try to alter your schedule to only every third day. If you wash your hair bi-weekly, you are safe to stay on that schedule. Nevertheless, be sure to wash your hair with cool water and a gentle shampoo. Also, detangle your hair gently and follow gentle combing and brushing practices between washes. There is absolutely no coloring allowed until three months after chemotherapy is over. During the time of your treatment and cooling scalp cap use, you can potentially save about 60% of your hair. This is a lot better than the alternative. The hair that eventually grows into the areas of your scalp that thinned during treatment will typically be darker and of a wire-like texture. The medical industry affectionately calls these strands “chemo-curls.” It will take you about 6 to 9 months to see the new growth because the hair buried in the hair follicle takes a while to grow out. But when it does there is a significant chance that it will look different than your original hair texture.

Types of Chemo

Doctors use two types of drugs to combat breast cancer after exploring the surgical option. The drugs are:

• Taxane drugs
• Anthracycline drugs

The difference between the two drugs is their approaches in attacking the cancer cells. Taxane drugs work by inhibiting the cancer cell’s ability to divide. Conversely, anthracycline drugs work by damaging the cell's genes and stopping their ability to multiply. Anthracycline drugs were the first chemotherapies to combat breast cancer, but the harsh effects on the woman’s heart have now made Taxane drugs the preferable course of treatment. However, in the early stages of breast cancer, anthracycline drugs are known to do the most damage to the cancer cells. Just like their difference in approach, taxane and anthracycline drugs respond differently to cooling caps as well. Anthracycline patients experience less hair loss with the non-FDA approved cold caps. Conversely, taxane patients are known to see results with the FDA approved cooling systems. Odd right?

Insurance Coverage

The two companies that are FDA approved to supply cancer treatment centers with cooling systems include Dignicap and Paxman. Both companies were initially cleared to treat breast cancer patients and then they received the approval to treat cancer patients with solid tumors. The cost of renting one of these cooling systems is anywhere between $300 to $400 per session. The downside is, because of the inconsistencies in the results of the types of scalp cooling and the limited amount of cancer patients that we benefit from the cooling, most of the time insurance companies will not cover the costs of the cap for the entirety of chemotherapy. Because rentable cold caps are not FDA-cleared, it put those using anthracycline drugs in a more expensive position because cancer treatment centers cannot supply those at all. A cancer patient must source a cold cap from a private company. This also acts as a barrier to achieving widespread insurance coverage. However, some insurance companies are stepping up. Aetna, the third-biggest insurer in the U.S., stated that they consider scalp cooling medically necessary as a means to prevent hair loss during chemotherapy. This has enabled patients to receive reimbursement after the initial use and out of pocket payment for the scalp cooling treatment. Blue Cross and United have also backed Aetna’s stance, allowing their patients to do the same.

Why Does It Matter?

When you look at the average person, you cannot see the trials and tribulations they are going through on the inside. After that person has conquered their latest battle, they do not have to deal with constant reminders of it day after day. That is how you should look at the side effect of hair loss during chemo. No woman wants to continuously look in the mirror to see a memory of the day to day pain she goes through to fight her cancer during chemotherapy. You can camouflage reconstructive surgery. But hair loss not only ruins any sense of privacy that a cancer patient once had. But it also reminds them that they are fighting for their life. If she can afford it, a scalp cooling treatment can give her that privacy back. Comment below with your thoughts on the scalp cooling treatment!