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Friday, December 28, 2012

Soon, You May Not Need Wigs During Chemo

By Heather Millar

Woman Losing Hair

With the flurry of news releases out of the San Antonio Breast Cancer Forum earlier this month, I forgot to mention the study in which I actually participated: an effort to see whether scalp cooling to help patients keep their hair during chemo seems to be safe and feasible.

Twenty lucky women being treated at University of California San Francisco and at Wake Forest University got the chance to avoid the baldness—and the wigs, scarves, and hats—that so often accompany chemotherapy. We all used a scalp-cooling system that made the blood vessels in our scalps constrict. The idea is that keeping the chemo drugs away from hair follicles will preserve the locks of cancer patients.

Several scalp-cooling systems are widely used in Europe, and also in Canada, Turkey, and the Middle East. I’ve written about the Penguin Cap system—dry ice caps widely used in this country but not approved by the Food and Drug Administration. For years, concerns about scalp metastases prevented studies that might lead to FDA approval of scalp cooling in the United States.

I’m happy to report that the researchers, led by my oncologist Dr. Hope Rugo, found that three-quarters of those of us who used the high-tech, computerized Dignicap kept 50 to 75 percent of our hair during chemo. Coolant was circulated through the caps and kept our scalps at a steady 5 degrees Celsius during our chemo infusions and for one to two hours after each infusion. An outer neoprene cap provided insulation and ensured a tight fit.

At an average of 15 months follow-up, none of us got cancer in our scalps. The system appears to be “minimally toxic,” that is, the downsides appear to be minor: Most of us reported feeling chilled. Some 65 percent of us took some pain medication to get through cooling. (I was one of those. I couldn’t have done it without Vicodin, frankly.) A few of us got a rash.

Researchers have to be serious about these things: telling the FDA they’re being silly is never going to attract funding or scientific cred. But to me, the risk of my breast cancer spreading to my scalp because I cooled it during chemo always seemed to be laughably remote. Before she started this “feasibility study,” Dr. Rugo—who’s nothing if not serious—did a review of studies that showed the risk of scalp metastasis to be about 1 percent. In the world of cancer odds, I though that was a slam-dunk.

Now, Dr. Rugo and her collaborators have data to back up my based-on-nothing hunch: It seems that the Dignicap worked for the vast majority of us. Even more important, it doesn’t seem to have any major health drawbacks. So next year, they’re going to begin a new, multi-center Phase I trial. This trial will enroll not only patients with Stage I cancer, but also those with Stage II cancer. I’ve got my fingers crossed that this study will also be successful.

I think this is great news for all cancer patients. Having cancer is bad enough without going bald into the bargain. The just-released study reports that patients who temporarily lose their hair during cancer treatment report lower self-esteem, poorer body image, and lower quality of life. That’s hardly surprising when you consider wigs don’t look like hair and are scratchy and hot. Scarves and hats are a pain. Who likes being bald and enduring weird looks from strangers?

If you can safely keep your hair during chemo, why not do so? Hopefully, this will soon be a widely accepted option for cancer patients.

Photo: Stockbyte

Posted by: Heather Millar at 8:50 am

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