More than half of women fitted with cooling caps kept their hair during chemotherapy in the world's first randomized clinical trial of the devices, said lead researcher Dr. Julie Nangia. Enlarge this image toggle caption Courtesy of Baylor College of Medicine Courtesy of Baylor College of Medicine 
 
 Half of the 95 women (50.5 percent) using the Paxman system lost less than half their hair after four rounds of anthracycline and taxane chemotherapy, including five women who had no significant hair loss, as judged by independent observers from photographs. The Paxman study was stopped earlier than planned, after four cycles of chemotherapy, because findings showed the cooling cap was highly effective at preventing hair loss. Two studies released Tuesday show that at least half the women who used either the DigniCap or another scalp cooling system, the Paxman, lost less than 50 percent of their hair. Among the 47 who did not use the cooling system, all lost all of their hair. She wrote an editorial accompanying the studies in JAMA, the journal of the American Medical Association. Researchers don't know exactly how the cooling caps work. And just one cooling cap, the DigniCap, is approved by the Food and Drug Administration. Or it may be that cold slows the growth of hair follicles, making them less susceptible to damage from chemotherapy, which targets rapidly dividing cells. Scalp cooling caps appear to limit this damage by constricting blood vessels in the scalp, reducing the amount of chemo that is delivered to the hair follicles, Nangia explained. Findings In a randomized clinical trial of 182 women with breast cancer receiving chemotherapy with a taxane, anthracycline, or both, those who underwent scalp cooling were significantly more likely to have less than 50% hair loss compared with no scalp cooling (50.5% vs 0%). Conclusions and Relevance Among women with stage I to II breast cancer receiving chemotherapy with a taxane, anthracycline, or both, those who underwent scalp cooling were significantly more likely to have less than 50% hair loss after the fourth chemotherapy cycle compared with those who received no scalp cooling. Again, all patients without the cap lost their hair, while hair loss was limited or halted in those who used the scalp cooling cap. Dr. Len Lichtenfeld, deputy chief medical officer of the American Cancer Society, says it could be that "by slowing down those cells whatever mechanism it may be — either starving their blood flow or slowing them down straightforwardly — the net effect is beneficial, causing hair not to fall out." Meaning This scalp cooling system was more likely to prevent alopecia than no treatment, and further research is needed to assess longer-term efficacy and adverse effects. But Hershman cautions that more study is needed to determine whether there is psychological benefit in using the caps to prevent hair loss. Scalp cooling devices cost between $1,500 and $3,000 per patient in the United States, and aren't reimbursed by health insurance, Nangia's study noted. Neither study found any short-term adverse effects caused by the cooling caps.
– Cooling caps are massively popular with European chemo patients and have been making inroads into the US, but two studies published Tuesday in the Journal of the American Medical Association offer some of the first clinical proof of their effectiveness. In one study, approximately two-thirds of breast cancer patients lost less than half their hair; in the other study, approximately half of breast cancer patients lost less than half their hair. The New York Times reports 5% of patients kept all their hair. The differences in effectiveness between the studies could have to do with the cooling caps being used, the medical centers applying the caps, and the chemo drugs involved, according to HealthDay News. The studies were funded by two different companies that manufacture cooling caps. Cooling caps are affixed to patients' heads before, during, and after chemo; a machine cycles cooling liquid through the caps. While researchers aren't exactly sure how the caps prevent hair loss, NPR reports, one theory is they restrict blood vessels in the scalp, reducing the amount of chemo that reaches the hair follicles. About half of breast cancer patients say hair loss is the most daunting part of chemo, and 8% say they would turn down chemo in order to keep their hair. One breast cancer survivor who used a cooling cap says it has psychological benefits. She tells the Times that losing their hair makes people "think they're sicker than they actually are." (A dose of magic mushrooms had a big effect on cancer patients.)