Beauty tip #10: avoiding hair loss during chemo with scalp cooling

The night before my diagnosis, I remember crying a lot. I didn’t cry that night because I was afraid of being diagnosed cancer, nor because I thought I could die. I was devastated about the thought of losing my hair. I know it may sound silly for those who haven’t gone through a cancer/chemo diagnosis, but it is not. Our hair symbolises much more than ‘just hair’, and is fundamental for self-stem and feeling ‘normal’ and healthy. My fears were confirmed on the following day, when the doctor confirmed I had ovarian cancer, and yes, I needed chemo and was going to lose my hair. I never felt so scared before, but I decided I was done with cancer messing up with my life and I was going to take control. Two days after I left the hospital I went to the hairdresser and asked her to cut my long hair as short as she could, so I could make a wig. It wasn’t all lost.

But then on the first day I saw the oncologist to discuss my chemotherapy regime, she mentioned that a scalp cooling system was available at the chemo ward. I decided to give it a try, and thanks to it I was able to keep my own hair for 3 months longer that I expected. I still got to use my wig thou, but that’s another story.

So what is scalp cooling and how does it work?

Losing hair has an enormously negative impact on women’s body/self-image and quality of life during cancer treatment.(1) The only effective treatment available at the moment is called ‘scalp cooling’. It uses hypothermia (very low temperature) before, during and after the injection of chemotherapeutic drugs to prevent hair loss.(2,3) This causes vasoconstriction of the blood vessels in our scalp, so there is less blood flow and less chemo reaches our hair follicles. The Paxman system, available in some hospitals in Melbourne, works through a coolant liquid which is pumped through a silicone cap attached to the cooling system.(4) In their brochure, they report a study in the UK that had 89% success rate in women doing treatment for breast cancer, with only 11% requiring wigs due to severe hair loss.(4)

The time you spent with the scalp cooling depends on the drug you are receiving. In my case, I had my head at -4oC for 30 min before, during the whole treatment and one hour after paclitaxel was delivered – sometimes there was even ice on my hair at the end of the session! Some chemotherapy drugs require the use of the scalp cooling for up to 3 hours after the treatment has finished. But you can still talk, eat, drink and even sleep or go to the toilet while using the scalp cooling system.

Are there any side effects? While the cap is comfortable, be prepared for a bad, almost unbearable, headache. I suggest taking 2 Panadol 30 minutes before it starts. The headache gets better after 10-15 minutes, so try to hold on. At the hospital I heard of several cases of patients who gave up after a few minutes because the pain was too great. If keeping your hair is important for you as it was for me, YOU CAN DO THIS. I cried a few times during these first minutes, but IT DOES GET BETTER and you even forget about it. You might also feel cold, but the nurses can provide a blanked to keep you warm.

My own experience: During the first half of my treatment, after enduring the chilling pain that unfortunately does accompany using these scalp cooling systems, I had significantly reduced hair loss, which meant I was able to appreciate having my own hair for about 3 months into the chemo and not having had to use a wig for too long. Why did it stop working? We had to change my treatment from weekly to once every 3 weeks. But I met a lot of women at the hospital having the 3-week cycles that had a full head of hair thanks to Paxman.

Would I recommend it to other women?

Definitely YES! It is totally worth the try, but you need to be willing to go through the pain in every single session you are receiving any drugs that can make your hair fall off. One session without it would be enough to make you lose your hair. It didn’t work for me until the end of the chemo, but IT DOES WORK for a lot of women. It is important to know, however, that even if you use a scalp cooling system you will experience some degree of hair loss.

Should you do it? I suggest you discuss the potential risks with your oncologist team to determine whether they think this is a viable option for you. Usually it is considered safe for breast cancer patients, as survival seems to be similar for those who used scalp cooling compared to those who didn’t.(5)

Finally, if you decide to go ahead with the scalp cooling, remember to be gentle with your hair – it will be more fragile than normally. But if you lost your hair, I can tell you now, 8.5 months post-chemo, that it is not the end of the world. I still feel upset if someone tells me ‘it’s just hair’, and I can’t wait for it to be as long as it used to be – which is going to take some years. But I still felt beautiful bald, and I hope you do too!

Love and health,

Fran xo

References

Choi EK et al. Impact of chemotherapy-induced alopecia distress on body image, psychosocial well-being, and depression in breast cancer patients. Psychooncology. 2014, 23:1103-10.
Van den Hurk CJ et al. Scalp cooling for hair preservation and associated characteristics in 1411 chemotherapy patients - results of the Dutch Scalp Cooling Registry. Acta Oncol. 2012, 51:497-504.
Shin H et al. Efficacy of interventions for prevention of chemotherapy-induced alopecia: a systematic review and meta-analysis. Int J Cancer. 2015, 136:E442-54.
http://paxman.de/downloads/fm_2013_03_11_10_30_52_8281.pdf
Lemieux J et al. No effect of scalp cooling on survival among women with breast cancer. Breast Cancer Res Treat. 2015, 149:263-8.