With all the advances in cancer treatment symptom management, the one that seems to have gotten away is a solution to hair loss. While some may think hair loss is minor since it’s primarily a psychological issue, studies show that some women will forgo chemotherapy options that mean they will lose their hair.

The one approach for keeping hair that continues to come around is scalp cooling, meaning the temperature of the scalp is lowered to constrict the blood flow to the hair follicles during peak concentrations of the chemotherapy. In 1986, I tried what was then called an ice cap before my first chemotherapy.

The nurse took what looked like a plump swim cap and pulled it over my damp hair with the idea that I would wear it during my chemotherapy infusion. The cap stayed on my head for 45 seconds before the pain in my temples caused me to rip it off and vow I would lose my hair before doing that again. It turned out not to be very effective, even for women who were able to stand the pain. Perhaps this was because new options have shown that the head has to be cooled consistently beginning before chemotherapy is administered and for a period of time after infusion has ended.

Today, with more known about how the cold works to keep the hair, there are two new versions of the cold cap, both of which come from research in Europe. The DigniCap, available to women at two test sites in the U. S., uses an inner and outer cap and is attached to a rolling unit roughly the size of a dishwasher. The unit cycles coolant through the cap 20 minutes before chemotherapy begins, during the procedure, and then for 30 minutes or longer after the treatment is over to give the body time to disperse the drugs. The outer cap insulates and ensures a tight fit.

The process isn’t perfect and can still be uncomfortable, but it depends on the woman and her tolerance whether it’s too painful to continue. Those leading the study say around 60 percent of women using the cap keep most of their hair.

The second iteration of the cold cap is the Penguin Cold Cap, a sectioned cap filled with a frozen gel that is applied tightly to the head before treatment. Because the caps warm up in 20 to 30 minutes, a patient will need a varying number of the frozen caps, sometimes as many as 15, and will need a place to keep them frozen until needed.

The caps are worn for a number hours after treatment depending on a formula that looks at drugs and dosage. Changing the caps might require some energetic family members or friends who will stay on duty for the required time.

One of the early proponents of the Penguin Cold Caps started a nonprofit (rapunzelproject.org) to promote the caps and raise money for freezers that are needed to keep the caps at the required temperature.

While there are still detractors who argue that cancer cells can lurk in the areas being cooled, statistics show the risk is minimal. The caps don’t seem to work as well for women who have already lost their hair to chemo and who need more treatment. Also, doctors recommend against those with hematologic malignancies using the cap because those cancer cells circulate throughout blood vessels.

If the DigniCap or the Penguin Cold Cap are approved by the FDA, it will be harder and harder to tell who is a cancer patient, and that’s progress.