Cancer Treatment Centers of America

The Rapunzel Project: Reducing chemotherapy-induced hair loss


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For women who are facing breast cancer treatment, a common fear is: Will I lose my hair?

Hair loss can be an especially difficult experience for women. It affects their self-esteem and makes a private disease a public matter. Often, women purchase wigs, scarves and other accessories to use during and after treatment, which can boost confidence and help reduce feelings of depression or anxiety.

Two friends and breast cancer survivors, Shirley Billigmeier and Nancy Marshall, caught wind of a potential alternative when Shirley was about to undergo chemotherapy. Cold cap therapy, or scalp cooling, was being used in Europe to help cancer patients save their hair. Now, thanks largely to Billigmeier and Marshall’s organization The Rapunzel Project, women and men in the U.S. are using the caps to reduce chemotherapy-induced hair loss.

What are cold caps?

Scalp cooling uses special caps that are placed on the head at a temperature of -22 degrees Fahrenheit, with the goal of preserving hair during chemotherapy. The caps are worn for several hours before, during and after each chemotherapy treatment. The freezing temperature of the caps constricts blood vessels that feed the hair follicles, which reduces the amount of chemotherapy drugs that reach the hair follicles.

There’s just one catch – most freezers aren’t able to reach the temperature that is required for cold caps to be effective. This means patients must use a dry ice method (which is more difficult to keep at a uniform temperature) or a biomedical freezer that can reach the required temperature.

Some people who haven’t undergone chemotherapy may wonder why hair loss is such an emotional side effect of cancer treatment. One common reason is that patients want to look like themselves, and not look ill. Privacy is another reason.

“There are a lot of people who don’t want the world to know they have cancer,” says Nancy Marshall, Co-Founder of The Rapunzel Project. “If you have chemo, you don’t have the option to keep your illness private. If you have chemo, the world knows.”

The Rapunzel Project facilitates the use of cold caps by helping hospitals purchase the freezers that make cold cap therapy more manageable and accessible. You can find a list of hospitals and facilities that have freezers here.

Cold caps are still in clinical trials in the U.S. However, people can rent their own caps directly from a manufacturer, such as Penguin Cold Caps. There is also financial assistance available to those who can’t afford the caps.

“At the end of the day, you’re doing something for yourself in the middle of a time when you’re so helpless and doing what everyone else tells you to do,” says Marshall. “Doing something positive for yourself can be emotionally exhilarating, and can really help with healing.”

Learn more about donating to The Rapunzel Project.

Learn about managing self-image during breast cancer treatment.