ó As a baby, Kim Nyalkaís now 7-year-old daughter would
twist her fingers through her motherís hair as she fell
asleep, and playing with her motherís hair is still a
Nyalka found out that sheíd have to have chemotherapy for
breast cancer, she started first looking into wigs, and then
into scalp cooling ó a treatment that uses cold caps on the
head to prevent hair loss during chemo ó to make the process
less traumatic for her family.
into her chemotherapy treatments, Nyalka, 47, of Whitehall,
Penn., has indeed kept her hair. It has been a cumbersome
process with each treatment requiring 80 pounds of dry ice,
hundreds of dollars, hours of brutal cold and plenty of
assistance from her husband, but for her itís been worth it.
really made this past year of treatment much less of an issue
ó for me and for my family," she said. "Just for
keeping normalcy in our family, not having her worry, and not
having her be afraid."
cooling, which has not been widespread in most places in the
U.S., may be on the verge of mainstream acceptance. One brand
of the caps, DigniCap, is nearing approval by the U.S. Food
and Drug Administration and will be available for use on a
limited basis at Magee-Womens Hospital of University of
Pittsburgh Medical Center once that approval comes through.
has a brand called Penguin Cold Caps, invented in England
about two decades ago and used in the U.S. for about 15 years.
The devices are not FDA approved, so patients must rent them
from the company and operate them themselves.
works by attacking dividing cells, such as cancer cells, but
also those in hair follicles. Scalp cooling constricts the
blood vessels that lead to the hair follicles, reducing the
amount of the chemo drugs that reach the follicles.
manufacturer of Penguin Cold Caps says that the technology is
effective in about 86 percent of patients, though that figure
varies depending on the specific chemo drug. A five-year U.S.
clinical trial of the DigniCap, released recently at the
American Society of Clinical Oncology, found that the caps
prevented hair loss in 70 percent of patients, versus the
control group where 100 percent experienced significant hair
U.S., only those enrolled in clinical trials have had access
to DigniCaps. Thousands of people in the U.S. have used
Penguin Cold Caps over the years, and about 350 are using them
at any given time, though "in Pittsburgh the numbers
appear to be lower than elsewhere," said Frank Fronda,
the companyís inventor and director.
has received chemo treatments at Allegheny General Hospital
every three weeks for about a year. For each treatment, she
and her husband pick up 80 pounds of dry ice from a facility
in the area and load it into special coolers they purchased.
The caps are rented from the company for about $600 per month,
and must be cooled to a precise temperature ó minus 22
degrees Fahrenheit ó that is colder than standard freezers.
scalp must be pre-cooled by the caps before the chemotherapy
begins, and the caps are left on during the therapy and for
about 3 to 4 hours afterward. The caps also must be changed
for a freshly cooled one about every half hour to maintain the
I first put them on, particularly during the first cooldown,
itís so cold it hurts," said Nyalka, who wears heated
blankets during treatments. "You sort of get used to it,
and then it doesnít bother me as much."
other cities nationwide, the process is somewhat simpler. A
Minneapolis-based foundation called The Rapunzel Project,
which works to make scalp cooling easier for cancer patients,
has donated medical freezers to dozens of cancer centers and
hospitals around the country when the facility or a patient
has requested them. Freezers, which eliminate the need for
patients to purchase and manage dry ice, are available in
Philadephia and Lancaster, Penn., but not in Pittsburgh.
Nyalka brought up the caps with her doctor, he didnít
discourage her from using them, but said he wasnít convinced
of their effectiveness. Other doctors are more skeptical.
donít personally recommend or use them," said Helen
Analo, an oncologist with Allegheny Health Network. "Itís
uncomfortable, itís not that effective, and most women
regain their hair anyway after chemotherapy."
Analo said that she has concerns about the possibility that
the caps will create a "cancer sanctuary" in the
scalp because the chemotherapy drugs are reduced there, citing
two case reports of patients who have used scalp cooling who
contracted cancer in the scalp years after treatment.
Brufsky, co-director of the comprehensive cancer center at
Magee-Womens Hospital and the University of Pittsburgh Cancer
Center, the recent DigniCap study presented at ASCO satisfied
his concerns about the possibility of scalp cancer. The study
found no evidence of an increase in scalp metastases in
patients who have used scalp cooling.
of UPMC patients who have "very very uncommonly"
used cold caps over the years. "The older technology does
work, but itís cumbersome and hard to use," he said.
newer DigniCaps stay on the patientís head for the duration
of the chemotherapy and do not need to be changed, keeping
their temperature constant by circulating a cold gel through
after the likely FDA approval, they will be available on an
extremely limited basis until the company perfects its
technology and scales up production. Magee is likely to get
only one unit at first, said Dr. Brufsky, which can be used by
just two patients at a time.
same time, the impact on patients can be profound. "Weíre
really making chemotherapy a lot easier on people," he
said. "One of the biggest side effects is loss of hair.
If this can address that, itís wonderful."
companies, such as Dallas-based Chemo Cold Caps and the
British Paxman Scalp Cooling, are also available for purchase
or in clinical trials.
effect of hair loss on cancer patients is about more than just
vanity, said Nancy Marshall, co-founder of the Rapunzel
Project, and a breast cancer survivor herself.
you have heart disease and you walk down the street no one
knows. When you have diabetes no one knows ó your medical
situation is your business. When you have cancer, itís
everyoneís business." She cites the benefits on a
patientís identity, privacy and empowerment that can come
from preserving the hair during chemotherapy.
is happy to have her daughter laugh about the "funny
cap" she wears home from chemo treatments ó while still
running her fingers through Nyalkaís hair. She is thankful
that she was able to afford the caps and follow the protocol,
and would like others to be able to share in that experience.
would love to see it more readily available to more
women," she said. "They ought to at least know that
you have a choice. Psychologically, it makes you feel like you
have some control over something that has happened to