Participants will be put on the scalp cooler before their first chemotherapy cycle
Mumbai: The Tata Memorial Hospital (TMH), Parel has started a clinical trial using technology to minimise hair loss due to chemotherapy. The initiative, the first such in India, is expected to address the loss of self-esteem and confidence that many cancer patients, especially women, face and reduce cancer-related trauma.
The trial, which involves four breast cancer patients initially, uses a scalp cooling technique to restrict chemotherapy medication from reaching the scalp, thus reducing hair fall. The machine has two scalp coolers, which are essentially specialised inner silicon caps containing coolants at temperatures of up to minus four degrees centigrade. The technique is widely used in the U.K. and the machine hase been brought to India free of cost.
The machine circulates the coolant in the caps, reducing its temperature and consequently blood supply to the scalp. As chemotherapy medication is given intravenously and circulated through the blood, the scalp gets less blood and thus less of the medication.
The trial is being headed by Dr. Jyoti Bajpai, associate professor, Department of Medical Oncology, TMH. She says chemotherapy medication works best on fast-dividing cells. Since cancer cells divide rapidly, the medicines attack those cells, but other cells like those in the blood, mucosal lining and hair follicles also come under attack.
“This is why patients suffer from reduced blood count, mouth ulcers and hair loss during chemotherapy. But of all the side-effects, hair loss has the worst impact on women. The fear of cancer becomes secondary and the fact that they will lose hair during treatment takes centrestage,” adds Dr. Bajpai.
Doctors grade chemotherapy-induced alopecia, or baldness, in three stages: Grade 0 for no hair fall, Grade 1 for less than 50 per cent hair fall and Grade 2 for more than 50 per cent hair fall (patients need a wig or head scarf). While hair loss starts soon after the first cycle of chemotherapy, there is none in a few cases.
“Through the trial, we are aiming at 50 to 70 per cent hair preservation. In Grade 1, women still feel confident as they are able to mask their scalp with the hair. We want to avoid the Grade 2 stage,” says Dr. Bajpai. The most common side-effects of using scalp coolers are headache and cold, but so far, none of the participants have reported these to be unbearable. The participants feel hair loss is a continuous reminder of the cancer and puts them in focus in a crowd.
Women participating in the trial will begin using the scalp cooler 30 minutes before starting chemotherapy and continue for an hour to 90 minutes after it has been completed. Doctors are maintaining pictorial records to evaluate the scalp cooler’s effect during every cycle. Trial subjects are asked to wash their hair well and not use hair oil on chemotherapy day, and their hair is covered with conditioner before the cap is put on.
The randomised trial, to be conducted over a year, has two arms: one with 34 patients who will be put on scalp coolers, and the other with 17 patients who will not be using the machine. All participants will start the trial from the first chemotherapy cycle. “We are taking non-metastatic patients in whom the cancer hasn’t spread. Also, to maintain uniformity, we have taken patients who are on Taxane- and Anthracycline-based chemotherapy,” Dr. Bajpai says. She adds that usually, patients are administered chemotherapy in two phases: four cycles of Anthracycline-based treatment before surgery and four three-weekly cycles or 12 weekly cycles of Taxane-based medication after surgery.
Dr. Bajpai cites the example of a 35-year-old woman who delayed cancer treatment as she did not want to suffer hair loss. “Another woman from Uttar Pradesh in her fifties was thrown out of her house by her husband and in-laws because of her baldness. Her teenaged daughters were also asked to leave with her. The family considered her disease and baldness to be an outcome of past sins,” she said, adding misconceptions and stigma attached to hair loss are worrying. “Women associate their femininity with hair. It becomes difficult to explain that the hair loss is temporary. Hopefully, such women will be benefited if our trial shows promise.”