Episode Transcript
Dr. Jones: Keeping a cool head while you're facing chemotherapy is so much more than being calm and level-headed. It's about protecting your crowning glory, your hair. This is Dr. Kirtly Jones from Obstetrics and Gynecology at University of Utah Health and this is about keeping it cool on The Scope.
Announcer: Covering all aspects of women's health, this is the "Seven Domains of Women's Health" with Dr. Kirtly Jones on The Scope.
Dr. Jones: Years ago, I was visiting a friend as she was undergoing chemotherapy. As I walked into the clinic, I knew . . . I saw that she was wearing a bright blue hat. A lot of women wear hats during chemotherapy because they're losing their hair or because they're cold and they want to warm up. But she had all of her hair and she had a lot of long, beautiful hair. She's a woman ahead of her time and ahead of our time.
As she told me that in Europe, they had regularly been using scalp cooling to decrease hair loss of chemo and she was going to try it. I don't think it had been done before in her clinic. Her blue cap was filled with cold, really cold, stuff, enough for an ice cream headache, for sure. And it worked. She lost some hair, but not so you'd notice, and finished her chemo with her crowning glory intact.
This year, two studies had been published in the U.S. to confirm this addition to chemotherapy, scalp cooling. One trial was called the SCALP trial. S-C-A-L-P stands for scalp cooling alopecia prevention trial. Alopecia is the medical term for hair loss, a side effect of many chemotherapy drugs that most women dread. The SCALP trial was published in the Journal of the American Medical Association, called "JAMA" by people who read it, 142 women with early stages of breast cancer undergoing chemotherapy with an average age of 53.
Now, this wasn't really early stage breast cancer because those people don't need chemo. But it wasn't late stage cancer, either. Half the women who had scalp cooling retained at least half of their hair and didn't have to wear a wig. And 5% of women who wore a cap lost no hair. All of the women who didn't have scalp cooling lost most or all their hair.
Another study published at the same time showed the same success. Again, the study was in women who had early breast cancer undergoing chemo. There were no serious adverse effects, but I'll bet there were some ice cream headaches for sure. The cool cap was worn before, during, and for a couple of hours after the drug infusion. In one study, about 90 minutes after. So how does that work?
Well, chemotherapy kills rapidly dividing cells. And of course, we are making new hairs every day so those cells are quite active. Blood flow delivers chemo to the cancer, but it also delivers chemo throughout the body. If you cool the scalp, you can strip the blood flow just as how your hands turn white when they're really cold. That means that less blood flow is delivered and less chemo is delivered. Also, cells that are really cold slow down their metabolic activity so the chemo doesn't have a chance to attack the chemistry of the cell.
The FDA has approved a cool cap called the DigiCap, D-I-G-I, so it can be used now here in the U.S. Scalp cooling is only for women with solid tumors and not blood cancers like leukemia. And, of course, it wouldn't be used in brain cancers. The use of the cap may not be paid for by insurance and it may cost several thousand dollars. For women who cannot afford to pay for the use of the scalp cooling devices, there's a non-profit organization called Hair to Stay, Google "hairtostay.org," that can help women and men with access to this therapy.
For many women, and probably men, hair loss with chemotherapy is an outward and visible sign of their illness. It robs them of their privacy. Of course, women can wear wigs and hats. But as a choice, many women would choose their own hair. Losing hair and having it regrow with the fashion and color changes that come with very short hair and chemo, and often grayer hair, has always been seen as a rite of passage in the chemotherapy journey. But if it isn't a journey that some women want to take, there's now an option. It doesn't work for everyone, but for those women for whom it did, it improved their sense of themselves and their quality of life.
So if you or a friend are soon to be undergoing chemotherapy and hair loss is just one more body trauma that you don't want to face, talk to your oncology team and keep a cool head. And thanks for joining us on The Scope.
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