For many women with breast cancer, one of the most worrisome side effects associated with chemotherapy is hair loss. With cold cap therapy, women receiving chemotherapy treatment at the Smilow Family Breast Health Center at Norwalk Hospital have options that can significantly reduce alopecia or the loss of their hair. For the last 30 years, practitioners and patients have attempted to prevent hair loss during certain chemotherapy regimens. Hair loss occurs because the chemotherapy agents target rapid growing cells in the body. This includes cancer but can also impact normally fast growing cells such as hair and nails. Success rates have improved greatly with recent advancements in cold cap therapy with reports of between 60 to 90 percent effectiveness.
The decision to use cold cap therapy is very personal and can vary between patients. However, there seems to be some shared desires among women including wanting to maintain their privacy, protecting their loved ones, and wanting to get back to “normal” as quickly as possible once treatment is completed.
Shaira Cohen, a chemotherapy nurse, fits Linda Lee’s Dignicap prior to her treatment.
Linda Lee, who is currently going through chemotherapy treatment for breast cancer at Smilow, is a nurse in Labor and Delivery at Norwalk Hospital. She explains that continuing with her normal activities while maintaining her privacy was very important to her. “A few of my colleagues have gone through chemotherapy treatment. I knew that if I had a choice I definitely would not want to lose my hair. I felt like it was an invasion of my privacy. I planned to work, I remember thinking that I don’t want my patients thinking that my nurse is so sick, who wants a sick nurse taking care of you. For me it was a very easy decision.”
Aggie Gussen Mirto shows off her full head of hair following her chemo treatments.
Another patient who has completed her chemotherapy using the DigniCap, Agnes (Aggie) Gussen Mirto, shares how thrilled she is with her decision to use the cold cap therapy. “I am very happy that five weeks post chemo I have an absolutely full head of dark brown hair. Although I did have a little thinning from brushing, you can’t tell that I went through any kind of treatment.”
Similarly to Linda, Aggie is a registered nurse. She is the Director of Nursing at The Carolton Conva-lescent Hospital in Fairfield, CT, and is a mother of an 11-year-old daughter. When she received the diagnosis of breast cancer at 41, picked up on her annual mammogram, she explained that she was in shock. “My diagnosis came completely out of left field. It was not genetic, no one in my family has had breast cancer.” Aggie’s focus quickly shifted to figuring out how to lessen the impact to both her patients and her daughter. “When I received the diagnosis of breast cancer I wanted to make sure that I expressed a heightened awareness of the disease to my staff. But I didn’t want my patients to think that the leader of the organization was sick. It was very important for me to be able to work through my entire treatment without my cancer being obvious.”
Although her patients were an important part of Aggie’s decision, clearly the most heartfelt reason to pursue cold cap therapy was her young daughter. “I have an 11-year-old little girl and I thought keeping my hair, not looking so sick, she might be able to accept my diagnosis a little bit more.”
The Smilow Family Breast Health Center at Norwalk Hospital has more experience than any other Connecticut hospital or medical institution in providing cold cap therapy. Starting in 2012 Smilow implemented a cold cap therapy pilot program for breast cancer patients undergoing taxane-based chemotherapy using Penguin cold caps. In this program, soft, gel-filled caps were chilled to a temperature of between -30°C and -32°C in a special biomedical freezer. The cold caps, which patients wear on their heads on treatment days — before, during, and after chemotherapy infusion — cool the scalp so that hair capillaries become temporarily dormant and do not absorb the chemotherapeutic drugs.
Mary Heery, APRN/Breast Health Specialist, working at the Smilow Family Breast Health Center, explains that the cold cap trial went very well. “We started using the Penguin cold caps and have had very good results, with 80 to 100 percent of patients achieving favorable outcomes in hair preservation, with people losing less than 50 percent of their hair.”
In December of 2015, the Food and Drug Administration (FDA) cleared the DigniCap Scalp Cooling System by Dignitana for female breast cancer patients in the United States. It’s the first device that has been granted FDA clearance to reduce the risk of hair loss during chemotherapy.
Mary notes, “We are pleased that Dignitana has received FDA clearance. In addition, the DigniCap technology means less time patients have to spend wearing the cold cap, so we were excited to try it. And we are hopeful that the results will be as successful as with the Penguin cold caps.”
Aggie encourages women to consider cold cap therapy. “This service was offered to me very early on in my treatment. For me, the DigniCap was very easy as it was already at the hospital. I was fitted for the cold cap and it was ready when I got there for my first treatment. I researched the options so I knew what to expect. The hardest part is the initial cold burst until the Ativan, given for discomfort, takes effect. You just have to remain calm and know it’s all for the good cause.”
With cold cap therapy, it is imperative that the cooling caps fit properly on each patient and have complete contact with the scalp. Smilow has arranged to have designated cappers, to work side-by-side with the chemo nurses, to assist patients with the fitting process. This allows the chemo nurses to focus on their patients and the infusions while the cappers administer the cold caps.
The DigniCap Scalp Cooling System consists of a tight-fitting silicone cooling cap connected to a special cooling and control unit. Sensors in the cooling cap ensure that the temperature is automatically regulated during the entire cooling treatment, never dropping below 32°F (0°C). DigniCap Scalp Cooling System is designed to provide continuous cooling with high efficacy, safety, and acceptable patient comfort. To make this process more comfortable, the cooling cap is at room temperature when placed on the head and the lower treatment temperature is gradually achieved over a short period of time.
Melissa Bourestom, Vice President of Marketing at Dignitana, explains, “We know that hair loss is a well-documented and common side effect of chemotherapy, but hair loss is not inevitable. Women now have a choice.” She encourages patients to explore this new option because “it allows people to keep their dignity, to keep their identity, and in many cases, keep their privacy.”
At this point, insurance companies do not cover the cold cap therapy but there are charities that can provide financial assistance for those in need. In April 2016 Norwalk Hospital received a grant from Pink Aid that enables eligible breast cancer patients to receive cold cap therapy not typically covered by insurance. “We are very excited and grateful to receive this Pink Aid grant,” said Zarek Mena, Certified Patient Navigator.
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