What is Cold Cap Therapy?

Cold cap therapy, or modern day scalp cooling, involves the use of a special cap or set of caps, cooled to very cold temperatures, and worn for a period of hours before, during and after each chemotherapy treatment. The cold temperature constricts the blood vessels leading to the hair follicles, reducing the amount of chemo drugs that reach the follicles during the period that the caps are worn, thus preserving the patient’s hair. (Of note the drugs stay in the patient's system far longer, but reach the hair follicles when they are at somewhat diluted strength.) This process has been in use in Europe for about 20 years. Several thousand individual patients in the United States have learned of and successfully used cold cap therapy in the last few years.


The Caps

A set of cold caps can be used at any location with the dry ice method. Patients acquire and freeze a number of caps, which are changed at specified intervals to maintain the proper level of cold. Some supportive chemo centers have biomedical freezers (see next section) so that dry ice is not needed. Please note that patients should always consult their physicians when considering cold cap therapy and should request success data for their drug regimen as part of their inquiries with the cap suppliers.

Penguin Cold Caps are the cold caps rented by most American patients. They have 20 years of data and are reported to work with virtually all chemo drugs.

Chemo Cold Caps are a new cold cap option. Their data so far indicates excellent success with TC and TCH. They are building data for other drug protocols.

 

A single cap system, where the patient puts on a single cap for the entire procedure and then cold liquid is circulated through the cap by an attached machine, is commonly used in other parts of the world. These systems are not available to most US patients yet but are in clinical trials (see home page for more on these trials).

DigniCaps - http://www.dignicap.com

Paxman Orbis System - http://www.paxman-coolers.co.uk

Penguin PCHS - Available on a limited trial basis to some patients in Texas and Michigan; see freezer list for details.

 

Financial assistance for patients renting Penguin Cold Caps may be available. Founded by another breast cancer survivor who successfully used Penguin Cold Caps, part of the mission of Cold Caps Assistance Projects (CCAPS) is to subsidize patients according to need, usually at least 50% of the cost of rental.  For more information see www.ccaps.org  or contact Patsy Graham at patsy@ccaps.org. 


The Freezers

Cold caps can be used at any location with the dry ice method. However a biomedical freezer is of benefit to both patients and infusion centers. It saves patients/helpers the cost and effort of acquiring and handling dry ice, keeps all caps uniformly cold, and minimizes the number of helpers needed by the patient. Of note, both methods work equally well.

The cold cap process  requires any freezer that can maintain a temperature of -30°C (-22°F). (Note that each cap has to be stored in its own box to ensure uniform temperature throughout.). Specifications for the freezer that The Rapunzel Project generally donates are as follow:

Model Number 34-09CCF, white chest style freezer
42” long x 24” deep x 35” high
140 pounds (210 pounds crated), on casters
Holds 28 cold caps in individual storage boxes (2 patients/day)Freezes to -34°C
8 amps, 115 volts
Quiet operation
Thermostatically controlled.
Lid lock with two keys provided
 

For a picture of this freezer, click here.

If your infusion center is interested in acquiring a donated biomedical freezer to support your cold cap users, please click here for further information.

 

Freezer Locations

(alphabetically by state)

The following list identifies locations with freezers available for cold cap users. Alternately in a few cases a PCHS is specifically noted. The PCHS is a new machine that uses a single cold cap to save the hair. It works in a similar way to the classic cold caps. Machines will become available at more locations in the future.

 

  • Beverly Hills Cancer Center – Beverly Hills, CA
  • Tower Oncology (Cedars Sinai) – Beverly Hills, CA  (3)
  • East Valley Oncology and Hematology (Disney Family Cancer Center) – Burbank, CA
  • Hematology Oncology Medical Group  – Encino, CA
  • Virginia K. Crosson Cancer Center, St. Joseph Heritage Healthcare  – Fullerton, CA
  • UCLA Hematology Oncology (100 UCLA Medical Plaza) – Los Angeles, CA
  • Chao Family Cancer Center, UC Irvine  – Orange, CA
  • Valley Medical Oncology – Pleasanton, CA
  • UCLA Porter Ranch  – Porter Ranch, CA
  • Ccare –  San Diego, CA
  • South Coast Gynecologic Oncology  – San Diego, CA
  • UCSF Carol Franc Buck Breast Care Center – San Francisco, CA
  • Santa Monica Hematology-Oncology Consultants – Santa Monica, CA
  • The Angeles Clinic – Santa Monica, CA (2)
  • UCLA Hematology and Oncology – 2020 Santa Monica Blvd, Santa Monica, CA
  • UCLA Hematology and Oncology-Parkside – 2336 Santa Monica Blvd, Santa Monica, CA
  • Kaiser Permanente – San Rafael, CA
  • Redwood Regional Medical Group – Santa Rosa, CA
  • Los Robles Hospital – Thousand Oaks, CA
  • UCLA Torrance Hematology/Oncology – Torrance, CA
  • UCLA Oncology Santa Clarita – Valencia, CA
  • Wellness Oncology & Hematology  – West Hills, CA
  • University of Colorado Cancer Center - Anschutz    –  Aurora, CO
  • Norwalk Hospital – Norwalk, CT
  • Hematology-Oncology Associates of Boca Raton – Boca Raton, FL
  • Lynn Cancer Institute – Boca Raton, FL
  • Morton Plant Hospital – Clearwater, FL
  • Broward Health Cancer Center – Fort Lauderdale, FL
  • Emerald Coast Cancer Center – Fort Walton Beach, FL
  • UF Health Hematology & Oncology  – Gainesville, FL
  • Memorial Breast Cancer Center – Hollywood, FL  (2)
  • Florida Cancer Specialists  – Largo, FL
  • Mount Sinai Comprehensive Cancer Center – Miami Beach, FL
  • Florida Cancer Specialists   – Naples, FL
  • Memorial Breast Cancer Center – Pembroke Pines, FL
  • South Miami Gynecologic Oncology Group – South Miami, FL
  • Tampa General Hospital – Tampa, FL
  • Atlanta Hematology/Oncology – Atlanta, GA
  • Peachtree Oncology-Hematology – Atlanta, GA
  • Piedmont Cancer Institute – Newnan, GA
  • Great River Hematology & Oncology – West Burlington, IA
  • Swedish Covenant Hospital Cancer Center – Chicago, IL
  • Oncology Hematology Associates of Northern Illinois – Gurnee, IL
  • Oncology Hematology Associates of Northern Illionois  –  Lindenhurst, IL
  • Block Center for Integrative Medicine – Skokie, IL
  • Memorial Regional Cancer Center  – Mishawaka, IN
  • Michiana Hematology Oncology – Westville, IN
  • Kansas City Cancer Center – Shawnee Mission, KS
  • University of Kansas Hospital Cancer Center  – Westwood, KS
  • Harbor Hospital – Harbor Cancer Center – Baltimore, MD
  • Medical Oncology, Dr. Frederick Smith – Chevy Chase, MD  (2)
  • Maryland Oncology & Hematology – Columbia, MD
  • Carroll Hospital Center – Westminster, MD
  • Oakland Medical Group/Michigan Healthcare Professionals  – Farmington Hills, MI
  • Cancer Care Associates, Rose Cancer Center – Royal Oak, MI
  • Hematology-Oncology Consultants, Rose Cancer Center – Royal Oak, MI
  • Oakland Medical Group/Michigan Healthcare Professionals, Rose Cancer Center – Royal Oak, MI
  • Hematology Oncology Consultants – Troy, MI

    ** PCHS – Botsford Hospital Medical Center – Farmington Hills, MI
    ** PCHS – Huron Medical Center – Port Huron, MI
  • Fairview Southdale Medical Oncology Clinic – Edina, MN
  • Minnesota Oncology Maplewood Cancer Center – Maplewood, MN
  • Minnesota Oncology/Abbott Northwestern Hospital – Minneapolis, MN
  • Coborn Cancer Center  – St. Cloud, MN
  • Bozeman Deaconess Cancer Center – Bozeman, MT
  • The Cancer Institute at Robert Wood Johnson, Hamilton – Hamilton, NJ
  • Beth Israel Cancer Center  – New York, NY
  • Columbia Medical Center at New York Presbyterian Hospital – New York, NY
  • Weill Cornell Breast Center at New York Presbyterian Hospital – New York, NY
  • North Shore Hematology Oncology Associates – Patchogue, NY
  • Cancer Specialist of Oklahoma – Oklahoma City, OK
  • Lancaster Cancer Center – Lancaster, PA
  • Chestnut Hill Hospital – Philadelphia, PA (Drs. Cantor, Biermann and Fellin)
  • The Miriam Hospital – Providence, RI
  • South Carolina Oncology Associates – Columbia, SC
  • Vanderbilt Breast Center at One Hundred Oaks – Nashville, TN
  • Methodist Hospital – Houston, TX

    ** PCHS – Texas Oncology, Austin, TX
  • The START Center For Cancer Care  – San Antonio, TX
  • Southlake Oncology  – Southlake, TX
  • Utah Cancer Specialists – Murray, UT
  • Virginia Cancer Specialists – Fairfax, VA
  • Meredith & Jeannie Ray Cancer Center  – Laramie, WY

Tips for Cap Users

A cold cap starter kit is now available. Created by a former cap "helper," this is one-stop-shopping for those who don't want to have to search for all the needed supplies. Click here to download the PDF.

1.  Use only cool water in shower 

2.  Wash hair no later than 3 days before and no sooner than 3 days after chemo 

3.  Use a gentle shampoo with ph similar to that of the hair in the 4.5 to 5.5 range. Use clear shampoos, not "milky" or "creamy" ones.

4.  Do NOT use products that say moisturizing or volumizing, or that are opaque (rather than clear). Such products may coat the hair and keep oxygen from reaching the hair follicles

5.  Use a detangling spray such as Kenra® Classic Daily Provision* (spray-on conditioner) rather than a regular conditioner. Again this helps keep the hair follicles from being coated

6.  Make the transition to these new hair care products as soon as possible before chemo starts, as it may take 2 weeks or more to fully clean old product residue off the hair

7.  Coloring hair is not recommended until 3 months after chemo is finished, because the follicles still need time to recover from the trauma of chemo

8.  Keep hair straight down during chemo; do not bunch or pile on top of your head

9.  Don’t pull on the roots

10.  Hold hair when combing so not to strain the roots

11. Sleep on a satin pillow case

12.  Do not use curling irons, electric rollers, or hot air hair dryers

13.  DRINK AS MUCH WATER AS POSSIBLE DURING CHEMO DAY

14.  Use adhesive-backed moleskin**, cut to the shape of the forehead, to protect skin when cold caps are on

15.  Have warm blankets, an electric blanket, or heating pads on hand to use, especially during and right after each cap change

16.  Sit in a chair without a high back – otherwise working at the back of the head during cap changes is difficult

17.  Use a travel-type neck pillow to support your head/neck during chemo

18.  Find out if you can have lab work done the day before chemo, because this shortens chemo day waiting time considerably

19.  Find out if you can call in and request to have your chemo order sent up from the pharmacy before you leave home the morning of chemo – saving you up to an hour

20.  Be sure to change the hair part line with each session of chemo. It helps to protect the scalp

21.  If you are looking for help camouflaging thinning hair, consider Nanogen Keratin Hair Fibers, which can be viewed here.

 

*Click here to find a location in your area that carries Kenra Professional™ hair care products.

**Moleskin Plus is a Dr. Scholl’s product that can be found in any drug store. Purchase the padding roll so you can cut it to the size needed for your forehead


Clinical Trials

Dignitana, a Swedish company, has successfully completed a first phase clinical trial of its DigniCap and has enrolled a larger patient group for a phase 2 study that is now underway.

http://www.dignicap.com/patients/information-for-us-citizens/

At this time, DigniCaps are not available to other U.S. patients. The DigniCap system involves circulating a very cold gel through a single tight-fitting cap, which is worn for the duration of the chemotherapy session, as well as for a period of time before and after chemo. For more information, go to www.dignitana.com.

The American doctors conducting this trial published a paper in March 2011, reviewing data from over 4,000 patients. They concluded that scalp cooling does not pose a risk for scalp metastases. Read the report.

As of February 2014, Paxman, a British company, has launched a clinical trial at the Baylor School of Medicine in Houston. The Paxman scalp cooling machine is also not yet available to other U.S. patients. http://www.paxman-coolers.co.uk/news/year/2014/month/March/

 

Research

Some of the more recent studies are listed below. Additionally there are links to the websites of the 3
leading cold cap manufacturers, where there is additional info.

 

From the Dignitana website (Swedish cold cap system now in US clinical trials)
http://www.dignicap.com/professionals/efficacy-of-scalp-cooling-with-the-dignicap-system/

From the Penguin Cold Cap website (British system, widely used in US as it doesn't require a machine, notably works with AC)
http://penguincoldcaps.com/clinical-trials/scalp-mets/

From The Paxman Cooler website (British cold cap system now in US clinical trial)
http://www.paxman-coolers.co.uk/professionals-downloads-resources-centre/ - offers downloads on efficacy and scalp metastases.
 

Scalp Cooling Bibliography

Also of note, a dedicated former user of Penguin Cold Caps has compiled an extensive bibliography of scalp cooling studies dating back to the 1970's. We have her permission to share this document, which can be found here.

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