Chemo patients
New technology may prevent hair loss in patients undergoing chemotherapy, considered one of the traumatic side effects of cancer treatment.
New scalp-cooling technology may prevent hair loss in patients undergoing chemotherapy, considered one of the traumatic side effects of cancer treatment.
Two studies released Tuesday — one led by Houston scientists — provide the first U.S. evidence that tightly fitted caps kept chilled by an automated system helped breast cancer patients retain their hair. Such caps are fairly new to the United States but more established in other countries such as Sweden and England.
“These are exciting results,” said Dr. Julie Nangia, a professor at Baylor College of Medicine and the principal investigator of one of the studies. “With breast cancer care coming so far in the last decade — lots of new treatments, patients living longer — it’s nice to have trials showing these devices can help women keep their hair and improve their quality of life.”
Nangia’s study, under
investigation at Baylor and six other sites since 2015, found that half of the patients who wore the caps kept all or most of their hair, compared with none of those who didn’t receive the cooling therapy.
Among the satisfied participants was Shawna Mayberry, 60, a recently retired schoolteacher in Arlington. She lost so little hair that people she knew would stop her to say, “I thought you were going through chemo; why aren’t you losing hair?”
Another multi-institution study, led by the University of California-San Francisco, found similar benefits from a competing cooling system for 66 percent of participants, though the higher number is likely because all received a type of chemotherapy more affected by cooling. The Baylor-led study results were similar when only that chemotherapy was considered.
Symbolism of losing hair
The studies were published in the Journal of the American Medical Association and accompanied by an editorial headlined, “The time has come” for scalp cooling to prevent chemotherapy induced hair loss. Anticipating the new systems will help “ease the distress,” it cited a previous survey that found 50 percent of respondents consider hair loss “the most traumatic aspect” of chemotherapy and 8 percent decline the treatment because of the concern.
“The symbolism of losing your hair during cancer treatment is powerful, and can be devastating for young women in particular,” said Jennifer Merschdorf, CEO of the advocacy group Young Survival Coalition and a breast cancer survivor. “It’s cultural short-hand for ‘being sick.’ It makes it hard to escape being viewed as “the girl with cancer.”
Both of the systems reported on Tuesday use a mobile refrigeration unit that circulates a liquid coolant through the cap, worn 30 minutes before chemotherapy, during the sessions and for 90 minutes afterward. Cold both constricts blood vessels so less chemotherapy is delivered to hair follicles and decreases enzyme activity that drives the attack on cells. Chemotherapy by nature attacks not just cancer cells but also healthy cells, particularly rapidly dividing ones such as those in hair roots.
Scalp freezing actually has been around for more than 20 years. Early models, still sparingly used, involve low-tech frozen caps worn for 15 to 20 minutes, then continuously replaced with another. The high-tech systems were developed and initially tested in Europe; little study had previously been done in the U.S.
Nangia said she expects Baylor will use the Orbis Paxman Hair Loss Prevention System, the one she tested, once it receives Food and Drug Administration clearance, likely in at least 90 days. The company submitted the Baylor study results as part of an application currently under review.
Nangia anticipates scalp freezing will roll out gradually, depending on demand and insurance coverage.
Paxman will charge from $1,500 to $3,000 depending on the length of the treatment, Nangia said. She said she hopes insurers will ultimately cover the therapy, as they do breast reconstruction, though it took the Women’s Health and Cancer Right Act in 1998 to make such coverage mandatory.
At MD Anderson Cancer Center, a top official said it’s good to have hard evidence showing scalp cooling can help prevent hair loss, but said it is still too early to make either of the systems part of its breast cancer care.
“This is a good start, but there are still a lot of issues to be worked out,” said Dr. Carmen Escalante, chair of general internal medicine. “Who’ll pay? Does it extrapolate to all patients and all types of chemotherapy? How does it affect scheduling in busy clinics? There needs to be further study.”
The Baylor-led study, the first to randomize participants into a group that got scalp cooling and a group that didn’t, enrolled 182 women with either stage I or II breast cancer who received at least four cycles of either of two types of chemotherapy. Of the first patients to complete treatment, 48 of 95 who wore caps had so little hair loss that they didn’t need a wig or scarf, whereas all 47 of those in the other group did.
‘A real blessing’
The most common adverse events from the caps were headaches.
The results caused Nangia’s team to stop accruing patients and halt the trial to release the data.
“It was a real blessing,” Mayberry said. “I could go on with my life without my hair declaring I have cancer. I felt like I had some control over the craziness of cancer.”
Nangia said she hopes to conduct future scalp-freezing studies with colon, lung and ovarian cancers. The therapy is only safe in solid tumors, not blood cancers.