Having battled bone cancer as a child, chemotherapy treatments had robbed Cassie Stratford of her hair once before.
So when the Henderson woman was diagnosed with Stage 2 breast cancer last year at age 32, she was determined not to lose her locks again — even if that meant forgoing treatments of the potentially lifesaving therapy.
“I remember being really sick and being bald … and I was like, ‘I am not doing that again, no matter what happens. I’ll do the mastectomy, but I’m not doing chemo,’” Stratford said.
A graduate of UNLV’s William S. Boyd School of Law, she reached out to a former classmate who also had battled cancer.
Stratford recalled having seen photos and reading Facebook posts about the woman, who had undergone chemotherapy but retained her hair with the help of a device called a cold cap.
“I just started researching everything I could about them online,” said Stratford, an attorney for Boyd Gaming Corp.
Filled with a gel that is frozen up to minus 44 degrees Fahrenheit, snug-fitting cold caps are worn by some breast cancer patients immediately before, during and after chemotherapy-infusion sessions.
The cold temperatures work to constrict blood vessels in skin on the scalp, thereby reducing blood flow as well as the amount of medication that is able to reach hair follicles, making hair less likely to fall out — a common side effect of the powerful cancer-fighting drugs.
Stratford used cold caps following her double-mastectomy surgery this year.
“There’s never a good time” to receive a cancer diagnosis,” she said, “but I felt like, ‘I’m 32. I don’t have time to put everything on hold for a year and have everyone look at me like I’m sick.’ … I wanted to decide who I wanted to tell (about her illness), and I wanted to go about my business at work normally.”
Also called hypothermia caps, cold caps have been used by breast cancer patients in Europe for decades. Following clinical trials, the U.S. Food and Drug Administration cleared one brand, the DigniCap Scalp Cooling System, for use in this country in December. Clinical trials of other cold cap devices are underway.
Several companies produce and rent cold caps, the bulk of which are not yet covered by most U.S. insurance companies. Even without FDA approval, various brands have been used for years in this country by patients who obtain them online without a doctor’s prescription.
Dr. Souzan El-Eid, a breast surgeon with Comprehensive Cancer Centers of Nevada, said she was “ecstatic” upon learning of the FDA approval.
The clinical trials, she said, helped alleviate concerns within the medical community over whether reducing the amount of chemotherapy drugs that reached the scalp could lead to cancer metastasis to the area.
“In general when you see metastasis, it’s really not in the scalp … so let the women keep their hair,” said El-Eid, who serves as Summerlin Hospital’s Breast Center director as well as president of the Clark County Medical Society.
El-Eid said she advises her patients who require chemotherapy about the caps.
“The first thing they ask me is, ‘Am I gonna lose my hair,’” and I’m like, ‘Yes, but it’s gonna grow back in,’” she said. However, “That period between losing (the hair) and it growing back in is devastating when they look in the mirror.”
Rental costs for the caps typically range between $350 and $600 or more per month depending on the number of caps and additional supplies needed, as well as how many rounds of chemotherapy a patient is prescribed.
“I would like people to feel free to do this. The issue is going to be the financial burden” it causes patients, said Dr. Mary Ann Allison, a longtime local oncologist who is at Comprehensive Cancer Centers’ southeast Henderson location.
Although she’s had four patients who use caps, Allison said most have declined them, citing cost concerns.
Patients also might feel burdened by having to store and prepare the caps themselves in advance of chemotherapy infusions. Because standard home freezers cannot reach temperatures required to cool the caps, dry ice, large portable coolers and other equipment also must be purchased and used to properly chill caps prior to each application.
Some doctors’ offices and cancer treatment centers, including Allison’s, provide special biomedical freezers in which patients can store their caps.
Comprehensive Cancer Centers’ freezer was obtained through a Minnesota-based nonprofit organization called The Rapunzel Project, which has donated the pricey appliances to 100 facilities throughout the country.
“There are some doctors who believe really strongly in how important (cold caps are) to patients and would like to make sure that every patient they treat has access to them,” said Nancy Marshall, co-founder of The Rapunzel Project.
Allison called the FDA clearance of the DigniCap system “probably the biggest psychological advancement” for women battling breast cancer. A woman’s hair “is such a huge part of your personality and how you want to look and how you want to be perceived.”
Cold caps are worn for approximately an hour prior to each infusion session and (with the exception of the DigniCap, which uses a computer to maintain a constant temperature) must be swapped out every 20 to 40 minutes during sessions. They also are worn for two to four hours afterward.
Patients typically are tasked with taking the caps on and off themselves, usually with help from a family member or friend who accompanies them to infusion appointments. In some cities, professional “cappers” can be hired to assist.
“This is not something that you need medical personnel” to do, Allison said.
The caps’ frigid temperatures can be difficult for patients to endure, often resulting in headaches, chills and discomfort in the neck and shoulders.
Also while using the caps — and for several months following the completion of chemotherapy treatments — special care is required to maintain the hair. It must be gently washed and cannot be conditioned, colored, blown dry or styled with heated tools. Vigorous brushing and combing also must be avoided.
Cold caps are not suitable for every breast cancer patient and cannot be used in conjunction with all chemotherapy regimens.
“There are some chemotherapies (medications) where you just can’t save the hair,” Allison said.
According to the website of the nonprofit Pennsylvania-based organization Breastcancer.org, small studies showed that cold caps were “highly effective” in 50 to 60 percent of women who used them. The makers of DigniCap as well as Penguin-brand cold caps also reported good success rates with the products on the companies’ websites.
Even under ideal circumstances, however, patients probably will experience some hair loss.
Tara Tilton, a patient of breast surgeon El-Eid, said she lost some hair on the sides of her head and at the base of her scalp when she used Penguin caps in 2009.
“It wasn’t super-noticeable,” recalled Tilton, who lives and works in the Las Vegas Valley as a sales rep for Colgate. “The main thing was, I did have scalp hair.”
She used the caps because, she said, “I didn’t want to go into these dentist offices (for work) and have people just stare at me and feel sorry for me because I had cancer.”
Despite experiencing success with the caps Tilton, a 39-year-old mother of three, called the process “overwhelming,” and said she is unsure whether she’d use them again in the future, if needed.
“It’s just uncomfortable, especially the first time. You’re stressed out (wondering), ‘Do we have it on right? Is it working? Is it worth it?’ It’s not pleasant,” she said.
“It definitely adds some stress to an already stressful time, but for me it was the right choice,” said Stratford, who experienced minimal hair loss while using the caps. “Most people would have no idea that I finished chemo a couple of months ago.”
Using cold caps helped Stratford feel in control of part of the treatment “that was going to be important and very visible,” she said. “When you lose all of your hair, you’re vulnerable … because you don’t have control over the public knowing what you’re going through.” Stratford said she wants more women to know that cold caps may be an option for them.
“I would hate for someone to choose not to have chemo because they didn’t want to lose their hair and look sick and have that psychological impact,” she said. “If someone does what’s right for them because of this, then I think that’s really the huge benefit.”
Correction: A previous version of this article incorrectly stated the FDA’s approval of the Dignicap.