The following article features in Issue One of the ST BREAST magazine.
Angela was first diagnosed with breast cancer seven years ago. It was a triple negative cancer and she endured six gruelling months of chemotherapy, losing her long blonde hair in the process. She recalls, “I looked like a cancer patient”. The Director of Research kept working in her leadership role, but felt that she lost her physical identity. When she faced a second diagnosis last year - this time with a completely different, triplepositive breast cancer - her oncologist Dr Yoland Antill discussed the newly available option of a cooling cap, to be worn before, during and after chemotherapy sessions in an effort to minimise hair loss. Angela received three months of chemotherapy with an agent normally associated with complete hair loss and opted to use a cooling cap to try and retain her hair. While uncomfortable – cooling caps basically reduce blood flow to hair follicles via a freezing process – Angela says the results have been “absolutely worth it”. She has retained “I would say 99%” of her blonde hair. But Angela admits the cooling cap process was difficult both physically and emotionally, and she is not sure she could have continued had she required a longer stint of chemotherapy. In this piece, Angela and her oncologist discuss the pros and cons of cooling cap technology.
Disappointingly, she had been recommended to have further chemotherapy for a completely different cancer but again, in the curative setting. This time around, she has had chemotherapy over a three-month period and this regimen would normally be associated with 100% hair loss.
Because Angela did not want to lose all her hair again, I discussed the use of cooling caps, something that was not available when she had her chemotherapy the first time. She finished her treatment ten days ago and has managed to retain most of her hair.
For her, it’s been worthwhile, but cooling caps are not for everyone. It really depends on many factors, including pain tolerance, anxiety, tolerance of cold, claustrophobia and the ability to tolerate additional discomfort in an already stressful situation. Some may need an antianxiety medication to help them relax – particularly for that first half an hour when their head is so cold, and they get that very constricted feeling. Some women find that nausea is increased with the use of cold caps and require additional medications on the day to manage this.
Cooling caps appear not to work so well for all hair types. The more hair a woman has, the less cool the scalp actually becomes. This technology is about reducing the temperature in the follicle, in the bulb. If you have very thick hair, then it may be more difficult to get penetration. There has also been a recent study in Japan and the rates of success in Asian hair are lower than with Caucasian hair, which seems to be best suited. For elderly women, when hair loss may already have been experienced, the cooling cap technology may not work as well.
Women do need to be careful which products they are using on their hair while they are undergoing treatment. I recommend avoiding products with parabens and sulphates, I have seen some women end up with a chemical clump – literally, a lump of matted hair that is fused together and there is no other option but to shave it to the scalp. This of course is an extremely distressing scenario, and one to be avoided if at all possible. While the scalp cooling companies do not include this as part of their recommendations, anecdotally I have found that the less a woman does with her hair like washing, colouring and brushing, the more she will retain.
It’s fair to say cooling caps are of benefit to many women, but they are not for everyone. About 20% of patients will discontinue due to things like pain, nausea, claustrophobia or headaches. I can remember seeing someone and she had made a celebratory and affirming sign to say ‘I am giving up scalp cooling today’. It was a liberating decision for her. The process of doing this to try and save her hair was creating such additional anxieties with each session and finally felt she could not do it anymore. She was very relieved when she made the decision to discontinue.”
Dr Yoland Antill
So, I was very open to using a cooling cap this time around, but it was not easy. The first 10-15 minutes after they put the cap on are the worst in terms of discomfort. You wet your hair first and put conditioner through it, and then the oncology nurse puts the cap on really firmly – it’s quite claustrophobic.
When the machine is switched on, it starts cooling and it tightens up – that coldness is very difficult to explain. They say it is like an icecream headache, but it’s not really. It’s so intense and you do want to rip the cap off.
That really uncomfortable feeling seems to dissipate after about 15 or twenty minutes. After that, it is still uncomfortable, but certainly doable. I did take Panadol to help me manage the process.
I was paranoid every time the cap was fitted. It has got to be fitted exactly right, because if it is not tight enough, you will lose your hair. If you have gaps, you will lose your hair in those places and then you are back at square one.
After I got through the first couple of treatments and I saw that I was retaining my hair, I became quite positive. You do have to be careful about not washing your hair too often, not manipulating it too much, not styling it or brushing it too often, and sleeping on a silk pillowcase to prevent friction.
I usually wash my hair every day, but I was lucky if I washed my hair every 10 days to two weeks. This was okay, because I think the treatment dries your hair out anyway. The real advantage of scalp cooling is that you can go around and look as normal as you can, because you have not got that visible sign of being on treatment. But this can also be a disadvantage, because people forget you are going through quite a difficult treatment process.
If I was one of those women who had to go through another few months of chemotherapy, I don’t know that I could have endured more of the cooling caps. The last few times I was counting down to the finish line. If I had to do this more, I would really have had to reconsider the ongoing use of the cap. But the positive outcomes can outway the trauma.
Now I have had breast cancer twice and I really don’t want to get it again. I just want to live my life and put this behind me and be healthy. My next goal is to finish working and just enjoy life. I am planning a big holiday and I want to be well.”