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A tightly fitted cap chilled to a few degrees above freezing, worn before, during and after each chemotherapy infusion, narrows the blood vessels of the scalp so less drug reaches the hair roots. In a randomised trial about half of women on taxane-based chemotherapy kept most of their hair, compared with none who went without.
Two machine-cooled systems are FDA-cleared: DigniCap (Dignitana; cleared December 2015 for breast cancer and extended to solid tumours in July 2017) and Paxman Scalp Cooling System (cleared April 2017 for breast cancer, extended to solid tumours in June 2018); manual gel caps (Penguin, Chemo Cold Caps, Arctic) that are swapped from dry ice every 20 to 30 minutes are the older, cheaper alternative. In the SCALP randomised trial (Nangia et al., JAMA 2017) 50.5% of women with early breast cancer using Paxman kept at least half their hair after four cycles of taxane, anthracycline or combined chemotherapy versus 0% of controls; the DigniCap cohort study (Rugo et al., JAMA 2017) reported 66.3% hair preservation on non-anthracycline taxane regimens.
Efficacy depends on the regimen: best with weekly or three-weekly paclitaxel and docetaxel alone, intermediate with docetaxel-cyclophosphamide, and poorest with anthracycline-containing regimens such as AC or EC followed by taxane, where preservation rates in trials were low. It is not used in haematological malignancies because of the theoretical risk of scalp metastases, though a systematic review of more than 1,900 breast cancer patients found scalp metastases in about 0.6% with cooling, similar to the rate without. The cap adds around 30 minutes before and 60 to 90 minutes after each infusion to the chair time; headache, chills and scalp discomfort are common but mild. Cost and reimbursement are the main barriers: the NHS provides it in many but not all units, often funded by charities such as Walk the Walk, and US coverage varies with charities (HairToStay, the Rapunzel Project) subsidising fees or lending manual caps.
Cooling the scalp to around 18 to 22 degrees Celsius vasoconstricts scalp vessels, reducing blood flow and drug delivery to the follicle by a large fraction during the peak plasma phase, and lowers follicular metabolic rate so dividing matrix cells take up less drug.
Query for this technology: (TITLE:"scalp cooling" OR ABSTRACT:"scalp cooling" OR TITLE:"chemotherapy-induced alopecia" OR ABSTRACT:"chemotherapy-induced alopecia"). Results are unfiltered search hits about Scalp cooling (cold caps: DigniCap, Paxman), not a curated reading list.
Shares Scalp care during and after cancer treatment, Persistent chemotherapy-induced alopecia, What recovery costs in the UK, and what it does not, Wigs, cranial prostheses and head coverings and the tags complementary, supportive-care, hair-loss.
Shares Persistent chemotherapy-induced alopecia, Minoxidil for persistent chemotherapy- and endocrine-therapy hair loss, Toxicity and quality of life are undervalued and the tags complementary, supportive-care, hair-loss.
Shares Persistent chemotherapy-induced alopecia, Minoxidil for persistent chemotherapy- and endocrine-therapy hair loss, Toxicity and quality of life are undervalued and the tags complementary, supportive-care, hair-loss.
Shares Persistent chemotherapy-induced alopecia, Minoxidil for persistent chemotherapy- and endocrine-therapy hair loss, Toxicity and quality of life are undervalued and the tags complementary, supportive-care, hair-loss.
Shares Low-level light therapy (photobiomodulation) for hair, Oral cryotherapy (ice chips) to prevent mucositis, Multinational Association of Supportive Care in Cancer, Devices and physical therapies roadmap: heat and light → electric fields and focused sound → drug-releasing implants and the tags complementary, supportive-care.
Shares What recovery costs in the UK, and what it does not, Body image after cancer treatment: how it is measured, what drives it, and what helps, Supportive care and survivorship roadmap: making treatment bearable → proving it extends life → caring for tens of millions afterwards, Survivorship and late effects are neglected and the tags complementary, supportive-care.
Shares Oral cryotherapy (ice chips) to prevent mucositis, Multinational Association of Supportive Care in Cancer, Toxicity and quality of life are undervalued and the tags complementary, supportive-care.
Shares Docetaxel, Paclitaxel / nab-paclitaxel, Toxicity and quality of life are undervalued, Triple-negative breast cancer (TNBC) and the tags complementary, supportive-care.