Montefiore Einstein Cancer Center is investigating whether traditional scalp cooling techniques can protect Black and Latina women with textured hair types from hair loss due to chemotherapy. The clinical trial, launched in October, has seen a promising start.
Dr. Beth McLellan, director of supportive oncodermatology at the center, said patients often consider permanent hair loss to be the most traumatic side effect of their chemotherapy. Given hair loss impacts 65% of people who undergo treatment, preventative scalp cooling therapy is a popular choice among patients. Yet, for women with curly or coily hair undergoing chemotherapy, there are no proven methods for hair loss prevention.
Chemotherapy attacks cancer cells and hair follicles indiscriminately — as both are rapidly dividing — resulting in hair loss known as chemotherapy-induced alopecia. Scalp-cooling therapies use tight-fitting headwear filled with cold gel or liquid to reduce blood flow to the area, slowing cell division and preventing chemotherapy from targeting hair follicles.
“We have seen women who actually decline chemotherapy or choose chemotherapy that may be less effective because they’re afraid of hair loss,” McLellan told the Bronx Times. “Hair can be a very important part of people’s identity and links to their culture and community, which can be even more important in Black and brown women. So, we think it’s very important to make sure that scalp cooling is available and effective in all patients, especially for those who have not been as well represented in prior medical studies.”
Typically, McLellan said, this process involves wetting the hair to improve conductivity between the cold cap and the scalp. For patients with textured hair, however, this process instead increases the barrier between the cap and scalp by promoting air pockets within the hair. Cold caps are most effective when close to the scalp, making the process generally less effective for patients with thick or tightly curled hair compared to patients with straight hair.
Montefiore’s study is testing whether specialized hair preparation can improve the efficacy of scalp cooling for patients with curly or coily hair.
Participants can select one of two branches of study in which to participate. The treatment group will undergo scalp cooling after participants’ hair is prepared with a deep conditioner and put into loose braids or twists by a partnering local hairstylist, while the control group will receive no specialized preparation for scalp cooling. McLellan said the investigators hope to identify whether preparation to reduce hair volume can better the results of scalp cooling for patients with textured hair.
Additionally, to investigate the cellular and genetic determinants of chemotherapy-induced alopecia, investigators perform genomic sequencing on participating patients by plucking hairs to identify possible biomarkers for hair loss. McLellan emphasized that the approach of plucking hairs is distinctively non-invasive as compared to traditional skin biopsies used for testing.
Since the trial kicked off in October, McLellan said the study’s first patient has seen promising results. After several rounds of therapy, the patient has seen “really good prevention of hair loss,” and is “overall happy with the progress.”
Over the next few years, McLellan said the study plans to enroll 30 women undergoing taxane-based chemotherapy, often used as a “first-line” therapy for breast, lung and gynecologic cancers, among the most common cancers in the Bronx. Enrolled participants will undergo scalp-cooling therapy free of charge.
“We’re also hopeful that beyond the trial, we will be able to continue offering scalp cooling for patients at Montefiore,” McLellan said. “There has been a recent addition of scalp cooling to Medicare coverage, and hopefully through advocacy over time we can have additional insurance coverage for scalp cooling. Our hope is really for all of our patients to have access to scalp cooling if they’re interested in pursuing that during their treatment.”
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