Before Deborah Cohan settled into her second round of chemotherapy, she dunked her brown ringlets in water and was fitted with a tight, silicone and neoprene cap that would cool her head to just above freezing.
“It’s like Amelia Earhart’s spa day,” she quipped, having set the mood with a music playlist that included India Arie’s “I Am Not My Hair.”
Cohan, a UCSF physician specializing in obstetrics and gynecology, was diagnosed with breast cancer in September. As a UCSF patient, she is participating in a clinical trial of more than 100 patients for DigniCap, an experimental treatment that cools the head during chemotherapy to reduce hair loss.
The loss of hair that comes as a side effect of many chemotherapy agents can be a devastating part of cancer treatment. Some patients see it as not just a blow to their vanity, but as a constant, visual reminder of their illness.
“It’s often the most devastating aspect of treatment,” said Dr. Hope Rugo, principal investigator for the study and director of breast oncology and clinical trials education at UCSF’s Helen Diller Family Comprehensive Cancer Center.
The idea behind the “cold cap” is relatively simple. Cooling the scalp causes blood vessels around the hair roots to constrict, making it harder for chemotherapy agents that result in hair loss to get to those follicles.
Mild side effects
While hair loss may not be completely eliminated, previous studies have shown it works and is well tolerated, although some patients report having headaches or feeling chilled. Sweden’s Dignitana, the makers of DigniCap, say its studies show that about 80 percent of women in Europe and Asia who used the system retained their hair.
The DigniCap study could lead to the first scalp-cooling device approved by the Food and Drug Administration. Other hospitals in the study include UCLA, North Carolina’s Wake Forest Baptist Medical Center, Weill Cornell and Beth Israel medical centers in New York.
DigniCap has been available in Sweden since the mid-1990s and is being used throughout the world, except the U.S., where it has not been approved for use. U.S. patients are using another scalp-cooling product called Penguin Cold Caps, which is made by a British company.
Those caps work on the same principle, but, unlike DigniCap, they aren’t connected to a cooling machine. To keep the scalp cold, patients have to continually change their caps – sometimes as many as a dozen times – during their chemotherapy sessions.
UCSF provides a freezer for the Penguin caps, but patients are required to rent the caps from the company at a cost of about $580 a month, or more than $2,000 for their entire treatment. Health insurers do not cover the expense.
“It’s a personal choice, and I know not everyone might be able to afford it,” said Tricia Strong, a sales representative for Penguin Caps in Southern California.
Strong, a native of England who lives in Malibu, heard about the concept of cold caps from family members in England after she was diagnosed with breast cancer at age 41 in 2011.
The former real estate agent used the Penguin caps, experienced minimal hair loss during chemotherapy, and decided afterward to work for the company.
Strong, a mother of two young children, said retaining her hair helped her get through treatment.
“I didn’t have to be reminded every day when I looked in the mirror,” she said. “It was real empowering moment for me when I thought there was something I could be in control of.”
Strong said Penguin’s cold caps do not need FDA approval because they are simply an external cap and not a device. “The FDA is aware people are using the Penguin caps and have not made a statement for or against it,” she said.