The cold cap system

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Prevention of hair loss
Preventing as much of the chemotherapy drug getting to your scalp as possible can do this. This is done using a cold cap that acts to cool the scalp and therefore restrict blood circulating in that area and reaching the follicles. The availability and types of cold cap used varies from hospital to hospital. The cap put on fifteen minutes before chemotherapy to start restricting blood flow, and kept on during and up to 1-2 hours after your chemotherapy. This does mean that your time in the unit is longer.

Not everyone can tolerate wearing the cold cap as it can feel very cold. It also increases the time spent in the chemotherapy unit as it must be worn for a little time after the infusion of drugs has finished. This discomfort varies from patient to patient so it is not a failure if you can't wear it and it has no influence on the outcome of your treatment. In a clinical trials to date, however, less than 2% of patients who had retained their hair did not continue with the procedure.

The cold caps are effective in preventing hair loss for most chemotherapy drugs. Some individuals however still loose their hair despite using it and some drugs are more likely to cause hair loss than others (see table below). Your doctor or nurse will be able to advise you.

How it works?
Studies have shown that scalp cooling is effective in preventing hair loss in patients treated with  some chemotherapy drugs. Cooling the scalp to a  temperature of +17 oC to achieve a subcutaneous temperature of +20 0C  (68 oF) constricts the blood supply to hair follicles diminishing or abolishing their perfusion hence preventing high chemotherapy dose delivery during the initial phase of chemotherapy. Further, coldness itself reduces the availability of (chemotherapy) cytotoxic drugs to the cells of the hair follicles by directly reducing their metabolic rate. It is the combined effect of both these mechanisms, induced by cooling the scalp, that prevents or reduces hair loss (alopecia). 

How effective is it?  
The cold cap system works better for some drugs than others. Clinical trials show a success rate of up to 85% with Docetaxel (taxotere), Epirubicin, Cyclophosphamide, Paclitaxel (Taxol) and many other drugs which as seen in the table below do normally cause hair loss without it., :-

Drugs which cause hair loss without the cold cap

Drugs which usually do cause hair loss

Drugs which sometimes cause hair loss

Drugs which usually don't cause hair loss

Adriamycin Amsacrine Methotrexate
Daunorubicin Cytarabine Carmustine(BCNU)
Etoposide Bleomycin Mitroxantrone
Irinotecan (Campto) Busulphan Mitomycin C
Cyclophosphamide 5 Fluorouracil Carboplatin
Epirubicin Melphalan Cisplatin

Docetaxel, (Taxotere)

Vincristine Procarbazine
Paclitaxel, (Taxol) Vinblastine 6-Mercaptopurine
Ifosphamide Lomustine(CCNU) Sreptozotocin
Vindesine Thiotepa Fludarabine
Vinorelbine Gemcitabine Raltitrexate (Tomudex)
Topotecan   Capecitabine

Find out more about cold caps:-


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