The phone lines at Penguin Cold Caps are ringing off the hook, or in business speak, “we are currently experiencing a high volume of calls due to our appearance on Good Morning America”. While the producer/supplier of the cold caps was not named in the GMA story, the idea that an icy head cap might prevent chemotherapy-induced hair loss seems to have sent some women running for the phone.

While still in clinical trials and little known in the United States, chemotherapy cold caps have been more widely used and studied in Europe. The headgear is stored at temperatures well below freezing and worn before, during and after chemotherapy sessions. The freezing temperature constricts the blood vessels supplying blood to the hair follicles, thereby limiting the ability of the follicles to absorb the chemotherapy drugs.

“You essentially put the hair follicles in hibernation,” said Shirley Billigmeier, breast cancer survivor and co-founder of The Rapunzel Project, a non-profit with a mission to increase American women’s access to cold caps. “The minute you have an option, your outlook switches,” said Billigmeier.

Patients need to rent the cold caps from the manufacturer, usually through a hospital intermediary. During chemotherapy, the caps are changed approximately every 30 minutes in order to maintain the optimal temperature of 22 degrees below zero Farenheit. It takes either a biomedical freezer or about 159 pounds of dry ice to maintain the caps at that temperature. Only a couple of hospitals in the U.S. currently have biomedical freezers.

Billigmeier had to get through her first chemotherapy and cold cap treatment with coolers of dry ice and a team of supporters. With seven family members and friends on hand to carry coolers and change the caps, Billigmeier got through her first treatment and returned for a second with a full head of hair. Friends and supporters of Billigmeier ultimately raised the funding to purchase a biomedical freezer for Abbot Northwestern, the Minnesota hospital where she was being treated. The cold caps go on about an hour before treatment and stay on for four hours following treatment, so cold cap users are looking at long days of treatment with no guarantee that the caps will work.

After six rounds of chemotherapy and cold caps, Billigmeier still had a full head of hair. The freezer she helped to raise funds for at Abbot Northwestern had already been used by about a half-dozen women as of last spring, according to an April 2010 article that appeared in the Minnesota Sun newspaper.

While there has been little to no research in the United States exploring the effectiveness or potential side effects of cold cap treatments, there was reportedly a 1990 study conducted in France that found them to be 90 percent effective in preventing hair loss. While some doctors are open to the idea if it helps their patients accept their prescribed chemotherapy regimen, cold cap treatments are not deemed safe for all cancer patients. Breast cancer is expected to pose little risk of blood borne cancer cells that could travel to the scalp, so preventing chemo drugs from reaching blood vessels in the scalp is perceived to be safe.

Hair loss is often one of, if not THE most devastating side effects for women undergoing cancer treatment. It is not unheard of for a woman to refuse a prescribed chemotherapy regimen due to her fear of hair loss. One of the major reasons that hair loss is such a devastating side effect is that it denies a woman the ability to keep her cancer diagnosis private is she so chooses. With this in mind, it is not hard to understand why some women may go to great trouble and expense to keep their hair.

Cancer diagnoses, hair loss, health and emotional well-being are all very personal themes. Each woman’s needs and responses to her treatment are her own. Even among those women who would like to be able to go to any length to save their hair from chemotherapy, the cost may be prohibitive. The fixed monthly rental cost of a Penguin Cold Cap is $429, along with a refundable $600 initial deposit. If your hospital does not have a biomedical freezer, then you will need a lot of coolers, a whole lot of dry ice, and a team to help you get the caps on and off quickly and smoothly enough that the chemo drugs do not make it to your scalp in the interim. According to The Rapunzel Project’s website, the caps are quite cold for the first 5 minutes after the new cap is applied, and the discomfort dissipates after that.

If you’ve never had cancer, never faced that kind of fear for your life and well-being, cold caps may sound like an automatic must-have. Having faced that fear of death by cancer, I personally think my fear of anything that prevents chemotherapy from circulating in my blood vessels would trump my fear of hair loss. It’s all about killing the cancer in my mind, as devastating as hair loss is. What about you? Would you put your follicles on ice to save your hair?

Susan Beausang,


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