Polk health officials weigh in on new weapons against hair loss during chemotherapy.
The Ledger – Your Health
By Robin Williams Adams / Your Health correspondent
Posted Feb 6, 2018
After the shock of a cancer diagnosis, then breast surgery, losing hair because of chemotherapy inflicts an additional burden on some breast-cancer patients.
Hair loss makes it harder to hide a condition patients may prefer to keep private for a variety of reasons, such as not wanting children, their parents or friends to worry or treat them differently.
“Loss of image is very critical, especially to breast cancer patients,” said Amy Bucciarelli, manager of clinic operations at the McKinley campus of Moffitt Cancer Center in Tampa.
“Having to lose their hair is another body insult … it can be demoralizing.”
Hair loss can occur with more than one type of cancer, although breast cancer in women generally gets the most attention.
“Having hair loss is an issue for women, obviously, and a lot of men,” said Dr. O. Abu Hlalah, oncologist at Bond Clinic in Winter Haven.
“It’s very impactful, psychologically.”
Some patients refuse to have chemotherapy or chemo drugs that carry a high likelihood of hair loss, which worries doctors no matter how much they sympathize.
“I’ve had plenty of patients who needed chemotherapy, in my opinion, but didn’t want it because they could lose their hair,” said Dr. Toan Nguyen, breast oncology director at Lakeland Regional Health Hollis Cancer Center.
Anthracycline chemotherapy medicines such as Adriamycin result in the most hair loss, according to the American Cancer Society.
These are among the emotional and practical reasons the Food and Drug Administration’s approval of two scalp-cooling devices has U.S. oncologists and oncology nurses interested.
“That is fascinating,” said Dr. Shalini Mulaparthi, an oncologist at Watson Clinic in Lakeland. “We have not started it yet, but we have had the representative come.”
Lakeland Regional Health oncologists want to incorporate scalp cooling into its care, Nguyen said, adding, “Many practices see it as an addition, but we see it as a core need.”
The DigniCap cooling system, by Dignitana, got FDA approval in December 2015 for use in helping reduce hair loss in female breast-cancer patients undergoing chemotherapy. It was the first of its type approved in the U.S., although different methods of chilling the scalp were being used.
The Paxman scalp cooling system got FDA clearance last year for treating breast cancer patients and is working for expanded approval for other cancers.
Moffitt began treating a few patients with DigniCap in early October. It’s done at the McKinley and International Plaza campuses.
Chemotherapy targets cancer cells and other cells that also divide rapidly.
The premise behind scalp cooling is that lowering scalp temperature results in less chemotherapy reaching hair cells. Activity within hair cells also slows.
Patients rather than doctors typically initiate the conversation about getting scalp-cooling treatment, Costa said.
“What they need to consider are, ’What are the chemotherapy agents and what is going to be the regime (under which they’re given),‴ Costa said.
Change from previous methods
Earlier efforts have included bags of crushed ice and caps chilled in special freezers or dry ice. These newer, self-contained scalp cooling systems circulate coolants inside a cap fitted for the patient’s head. They cool continuously and don’t need freezing or ongoing cap changes.
Studies released Feb. 14, 2017, in the Journal of the American Medical Association found demonstrably less hair loss in women given scalp cooling than for those in control groups who didn’t. One involved DigniCap and the other Paxman.
At least half of women on either of those cooling systems while in chemotherapy lost less than 50 percent of their hair, the studies found.
In one of them, about two-thirds given cooling kept their hair. Some large European studies had similar results, said Bond Clinic’s Hlalah.
“Those who underwent scalp cooling were significantly more likely to have less than 50 percent hair loss after the fourth chemotherapy cycle,” said authors of the article on the Scalp Cooling Alopecia Prevention (SCALP) trial with Paxman.
Patients getting scalp cooling in the DigniCap study reported feeling less upset about hair loss and less dissatisfaction with their bodies than those in the control group.
Likelihood of hair loss is higher with Adriamycin and cyclophosphamide followed by Taxol or generic paclitaxel than it would be with Taxol and cyclophosphamide alone, Costa said as an example.
“I’ve seen a lot of cold therapies come and go,” Bucciarelli said.
“I thought at first this might be another fad coming through, but I’ve been quite impressed so far.”
DigniCap’s website shows Moffitt as one of 15 sites in Florida, with eight more coming later this year. It listed 85 sites nationwide, with more planned.
Paxman listed 59 U.S. sites, one in South Florida, but plans significant expansion.
Other factors to consider
‒ There’s an added time commitment.
Cooling done before and after each chemotherapy infusion makes sessions longer than chemotherapy alone, Hlalah said.
“Patients try to find a balance between that investment and the potential for discomfort,” Costa said.
‒ Women react differently to cold. A few report discomforts like headaches and sinus pain or scalp pain. Some find the caps uncomfortable, although the DigniCap chin strap recently got redesigned for more comfort.
‒ Flexibility may be possible in how often doses get administered, such as giving Taxol biweekly up to four times or giving it weekly 12 times, Costa said.
‒ Patients need to check with their insurance companies to see whether the cost of scalp cooling will be covered.
Robin Williams Adams can be reached at [email protected]