Expect Questions About Cold Caps to Spare Hair During Chemotherapy

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For patients who have confronted a diagnosis of cancer, then endured weeks of chemotherapy, it would seem that losing their hair would not be a big concern. But for many patients, it can be.

“You have to spend a year either putting on wigs or announcing to the world that you’ve had chemotherapy,” Hope Rugo, MD, Director of Breast Oncology and Clinical Trials Education and Professor of Medicine at the University of California, San Francisco (UCSF), commented in an interview with The ASCO Post. There is, however, another option, one that Dr. Rugo and her colleagues have been evaluating through studies at UCSF and collaborating instutions.

The UCSF is one of the five institutions that participated in a pivotal trial evaluating the effectiveness of the DigniCap Scalp Cooling System in women receiving chemotherapy for early-stage breast cancer. The majority of patients in that trial achieved the primary endpoint of less than 50% hair loss 1 month after completing their last cycle of chemotherapy. Data from that trial have been submitted to the U.S. Food and Drug Administration (FDA) for approval. At UCSF, Michelle ­Melisko, MD, has also set up a registry study to follow patients using Penguin Cold Caps. These caps also have not yet received FDA approval, but patients interested in trying the Penguin Cold Caps can rent them through the Penguin website (

Motivation Is Key

There are no particular characteristics suggesting who would be a good candidate for using cold caps. “I think anybody is, as long as she doesn’t mind the cold,” Dr. Rugo said. “Some people say they can’t stand being cold or are too nervous about the chemotherapy.  For others using the Penguin cold cap, the need to have a helper and change the caps every 30 minutes is a challenge. I think motivation is the main thing, and many women are highly motivated.”

Wearing warm clothing or covering the body with a blanket may combat the discomfort of the freezing caps. Some patients find drinking warm liquids helps. Patients using scalp cooling are also advised to be gentle with their hair, avoiding coloring and blow-drying. “We tell people not to wash their hair more than a couple of times a week and to use nonsulfite-containing shampoos,” Dr. Rugo said.

Although the studies at UCSF and collaborating institutions have involved only women, Dr. Rugo said that men have expressed interest in the scalp cooling system and have used it in other countries. The Penguin Cold Cap website reports that the caps can be used by people of any gender, age, nationality, and type of hair and with many types of cancer.

For More Information

Patients interested in more information about cold caps and issues involving their use can be directed to Dignitana (, Penguin (, paxman (, or The Rapunzel Project (, a nonprofit organization dedicated to helping chemotherapy patients keep their hair during treatment. ■

Disclosure: Dr. Rugo reported no potential conflicts of interest.


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