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 over 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 individual 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 were first used in the US in 2005, and have been widely used over the last several years. They have their own unique design and patented gel to hold temperature as long as possible. Penguin has over 20 years of data and experience and their caps are reported to work with almost all chemo drugs. Of note, in addition to very high success rates with taxanes like TC, they report their success rate may be as high as 75-80% with patients using AC. AC is usually toughest on the hair, and this appears to be a better outcome than any other type of cap at this time, to our knowledge.

 

Chemo Cold Caps began in 2012 after the co-founder saved her hair using cold caps. CCC uses an Elastogel cap with an outer insulated cover and a special 4 point strap to ensure a snug fit. They provide caps, cooler, and all needed supplies for each rental. Clients report their website and customer service are excellent.  CCC data indicates a very high success rate with the taxanes. Inquire regarding other drugs.


Arctic Cold Caps started in 2015, again inspired by a family member who saved her hair using cold caps. Arctic also uses an Elastogel cap, and provides caps, cooler, and all needed supplies for each client. One-on-one training is available via Skype. Newest to our list of recommended providers, Arctic has received a number of compliments from their users and the medical staff involved in their care regarding their successful outcomes and their customer service. They report excellent results with the taxanes and a number of other drugs. Please inquire for details.

 

Wishcaps began in 2013, after the founder assisted a close friend who saved her hair with cold caps. Wishcaps also uses Elastogel caps, and provides renters with all needed supplies including cooler, digital timer and laser thermometer. Newest to our list of recommended providers, both patients and clinic staff confirm that Wishcaps offers outstanding customer service. Phone consultations are available to all clients. Wishcaps reports excellent results with the taxanes. Inquire regarding other drugs.


A single cap system, where a machine circulates cold liquid through a special cap, is commonly used in other parts of the world. The DigniCaps® system was approved by the FDA in December 2015. DigniCap systems are now shipping to U.S. locations and will be noted on our locations list as we receive the infomation. Other clinical trials of machine systems continue (see Trials/Research subsection for more information).

DigniCaps® - http://www.dignicap.com

Paxman Orbis System - http://www.paxmanscalpcooling.com

 

Financial assistance for patients using 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 for $300 for up to 4 months. For more information go to www.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 the freezer or DigniCap location closest to you, click here.

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.


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 gently 

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, once all chemo treatments are finished, 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, successfully completed first- and second-phase clinical trials of its DigniCap®. In December 2015 Dignitana received FDA (Food and Drug Administration) clearance to market the DigniCap® System in the United States.

http://www.rapunzelproject.org/LinkClick.aspx?fileticket=KR8CTcnM2M4%3d&tabid=58

DigniCaps® are now being installed in US chemo centers. 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 not yet available to other U.S. patients. http://paxmanscalpcooling.com/the-system/clinical-trials

 

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 FDA approved)
https://www.dignicap.com/professionals/

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://paxmanscalpcooling.com/scalp-cooling#safety - 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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