Cold caps helped this woman keep most of her hair during chemotherapy
When she learned she had breast cancer, Barbra Vukich's thoughts turned to her daughter.
Vukich, 52, of North Sewickley didn't want to distract the 18-year-old from her senior year in high school, so she delayed telling her about the Dec. 22, 2015, diagnosis for as long as she could.
She worried that the possible hair loss from chemotherapy would attract attention at her daughter's graduation, where she was to be valedictorian.
So Vukich tried to keep her hair by cooling her scalp with so-called cold caps during treatment, a strategy clinical trials recently have proven effective for some women. The devices constrict blood vessels, limiting the flow of chemicals to hair follicles to preserve them.
“For my daughter's graduation party and for her speech, I had my hair,” Vukich said. “That was June. By then most people wouldn't have had hair. So to me, the cold caps worked.”
Women have used different versions of the caps for years, but doctors just published results from the first top-quality clinical trials to test the devices. The caps helped half or more women with breast cancer keep their hair through treatment in two randomized, controlled studies published in the Journal of the American Medical Association.
While more research is needed, the caps could improve quality of life for women facing a disease that is often treatable, said Dr. Julie Nangia, lead author of one of the studies and an assistant professor of medicine at Baylor College of Medicine in Houston.
“For early-stage and curable breast cancer, this is something that hopefully will be offered to most women in the years to come,” Nangia said.
Nangia's trial used the Paxman Scalp Cooling System, which circulates coolant that a machine keeps between about 23 and 25 degrees Fahrenheit. Forty-eight of 95 women with breast cancer who used the device preserved their hair, and all 47 women who didn't use the device lost their hair, according to the study. No serious side effects were reported.
Paxman is seeking U.S. Food and Drug Administration clearance for the device, which is not available outside clinical trials, Nangia said. The other trial published by JAMA tested a device called DigiCap, which received FDA clearance in late 2015.
Neither device is available in Pittsburgh. Vukich used a less sophisticated system involving her husband and two beer coolers full of dry ice.
She ordered eight refreezable caps from Penguin Cold Caps, an online company. The night before each round of chemo, her husband, Craig Vukich, 53, picked up dry ice from a welding supply company. He woke up at 2 a.m. to pack the caps in the ice so they would be the right temperature — 33 degrees below zero — before starting treatment.
He put the first cap on her head an hour before treatment and replaced them every 20 minutes throughout the treatment, which usually lasted about four hours. Then he kept replacing them for another couple hours after treatment, pulling over in the snow on drives home from the hospital to swap in frozen caps.
Barbra Vukich said a warning on the packaging about the discomfort didn't fully prepare her for the experience, during which she got a couple of burn marks from the dry ice.
“It tells you how uncomfortable it is, but it doesn't tell you how cold it is when it's on your head,” she said. “By that time, I had paid for it. ... I said I would suffer through it.”
She rented the caps for about $600 per month and paid $100 per trip for the dry ice, she said. Insurance doesn't cover the cost and rarely pays for wigs.
The Penguin cold caps have to be kept at such a cold temperature because they warm up during the time between changes, Nangia said. The coolant systems tested in the clinical trials maintain a constant temperature.
Vukich started chemo at Magee-Womens Hospital of UPMC and finished it at UPMC Heritage Valley Cancer Center in Beaver. She used the caps at both places. She said a couple of other women had used it at Magee, but she was the only one at Heritage.
Her surgeon, Dr. Mary Beth Malay, director of the Allegheny Health Network Breast Center in Wexford, hadn't heard of the caps before Vukich introduced her to them.
Malay and Nangia said one of women's biggest fears when they learn they have breast cancer is losing their hair.
It affects body image at a time when they already are going through the difficulties of a cancer diagnosis and treatment, and a bald head signals the disease when many women would prefer to keep it private, Malay said.
“They just want to feel normal, and when you lose your hair, you don't feel normal,” she said.
She said she supports using the treatment depending on the drugs used in a woman's chemotherapy regimen.
Nangia's trial tested the Paxman cap only in women with breast cancer, but future trials could test the devices for other types of cancer and could include men, Nangia said.
“I think this is important to everyone, whatever their tumor type or whether they're a woman or a man,” she said.
Nangia's study in JAMA found that the cooling device helped 59 percent of women who used a class of drugs known as taxanes keep their hair. Only 16 percent of women who used a class known as anthracyclines kept their hair. The other study in JAMA excluded anthracyclines. In that study, about 66 percent of women who used a cooling device kept their hair, while all women who didn't use the device lost their hair.
Both types of drugs are common, Malay said, adding that women “need to exercise caution when applying that JAMA study.”
Malay said Vukich did not take an anthracycline.
Craig Vukick said his wife kept most of her hair even though she lost some of it.
“Was it perfect, by any stretch? No, but you couldn't tell by looking at her from her hair that she had cancer,” he said.
He said his wife's decision wasn't about vanity but about avoiding extra attention or feelings of pity from others.
“She's not vain, but my wife's a strong woman,” he said, “and she didn't want anyone to know she was sick.”
Wes Venteicher is a Tribune-Review staff writer. Reach him at 412-380-5676 or firstname.lastname@example.org.