Cancer patients can now potentially avoid losing their hair from chemotherapy as a lobby group has donated two scalp-cooling machines to Sir Anthony Mamo Oncology Centre.

Four patients at a time will be able to use what are known as cold caps to possibly retain their hair, an important step for them as chemo-induced alopecia is considered by many to be the hardest and most feared side effect of treating their illness. In fact, about eight per cent of patients refuse chemotherapy to avoid it.

Hair loss is known to have a debilitating impact on a patient’s life and livelihood. Retaining hair can help to improve self-image and quality of life during therapy, as well as provide a level of privacy around a cancer diagnosis and leave a positive impact on their emotional well-being.

Results may not be guaranteed and scalp cooling works 50 per cent of the time, retaining half of the hair on average.

However, the success rate did not stop a determined Sue Domancich from looking into this option as soon as she was diagnosed with breast cancer in 2020, aged 46. At least, she had the choice to try it out. Her oncologist approved and, in her case, it worked.

Domancich has since strongly supported Action for Breast Cancer Foundation in its drive to make the €60,000 machines accessible to everyone at hospital and not just privately.

One woman's cold cap experience

Her motivation to push for it? She recounted that hair loss was one of her greatest concerns, both mentally and physically.

“I wanted to be normal,” she said. “I consider myself vain and this was very important to me.”

When she learnt about the cold cap, Domancich started reading more and bought books on it.

“The cold cap gave me strength… I tried on bandanas before my hair would fall off to see how I looked. I was upset about losing it; maybe more than having to undergo a mastectomy. That was a bit too much for me.

“Of course, my health was first and I told my doctor to give me the hardest medicine even if it would only reduce the risk of recurrence by just one per cent.

“Still, I wanted to try and save my hair in the process.”

An accountant and compliance officer, Domancich continued working throughout her six months of chemotherapy.

“I was able to attend online meetings without looking any different. Then, I would sleep after.”

The young mother’s proactive reaction to her diagnosis after the initial shock was a surprise even to herself. She went into research overdrive to be sure she was informed and in control.

“I thought I would just cry and that’s it.” But, instead, she began “ticking the boxes of my checklist, marking this done and that done. I kept a whole diary with a detailed plan of action, and I still have it.”

Domancich felt endowed with a strength she never thought she had and started “calling everyone and everywhere” to get the ball rolling.

With the help of her oncologist and surgeon, the “bold and hard-headed” woman left no stone unturned.

“I googled breast cancer survivors for inspiration and started creating bonds. I got support and, now, I feel I want to give it back and pass it on,” Domancich says about her advocacy for the cold caps.

She acknowledges that the cold caps are not necessarily the right decision for everyone and there is no certainty they are going to work but, where it is recommended, she feels there is nothing to lose.

“If the chemo lasts six months and you only lose your hair in the final two, that is already better. Normally, the hair falls off two weeks into starting the sessions, But, right after chemo, it starts growing again.”

Neither did she find the procedure an additional burden to coping with her illness, as her sister would point out to her, asking her to stop it and not add to her plate.

The cold caps are worn around one hour before chemo, during the treatment, which could last around three, and for about another hour after, extending the process each time. But that did not put her off and retaining her hair had a positive impact on her morale.

Just a hairband

Domancich embarked on a “rollercoaster ride”, starting with a lumpectomy and ending with complex breast reconstruction surgery, which involved a DIEP flap, whereby muscle was removed from her back.

But she was armed with a full head of hair throughout her battle, and when it was over around six months later, she went out with her friends, looking the part and just wearing a hairband to hide any patches and bits that had thinned.

“By the end, I had lost every hair on my body, and I had tattooed my eyebrows, but I still had my hair on my head.”

The cold cap is attached to a system that circulates coolant through it, reducing the temperature of the scalp. It is important that it is fitted well and tightly so that no air enters, Domancich explains, adding that, because she wore a hairband to cover her ears and protect them from the cold, it was not as effective on the hairline.

She is also aware that some patients may not withstand it. Though the first 15 minutes of treatment can be challenging, the body quickly acclimatises to the cold.

Essentially, the cold cap freezes and numbs the scalp, while chemo infusion does its job. Really, it brings the head temperature, which is much hotter than the rest of the body, down to 18°C but the machine marks -5°C.

“I feel I had to go through this,” she said, looking back to her cancer diagnosis. “Then, I started along another path and chapter. I met Esther Sant.”

The chairperson of Action for Breast Cancer Foundation, Sant recalls the days, 20 years ago, when ABCF started lobbying and accumulating funds for “good and tangible” causes for “fresh and vulnerable” breast cancer patients.

A cancer survivor herself, her first fight was for a proper breast prosthesis as opposed to the shoddy and ill-fitting ones available.

More recently, ABCF worked tirelessly to offer the Oncotype DX test at hospital, meaning around 55 women who qualify for it can save €3,000 and may not have to undergo unnecessary chemotherapy.

Speaking during Breast Cancer Awareness Month, Sant said the cold cap devices donated by ABCF will be for all cancer patients and not just breast sufferers.

Sant praised the support of the oncology centre nurses and other key figures both there and at hospital, including researchers, who helped to make it happen.

Chemo sessions will be extended due to the use of the cap and nurses have had to familiarise themselves with the machines. Their introduction has involved translating information leaflets into Maltese and writing policy in connection with the cold caps.

“Their input has been: ‘If it makes patients happier…’,” Sant said about staff members at the centre.

Hers was considered a “super success story” with over 20 years in remission, but, pushing 60, she recently found herself fighting metastasis to her vertebrae.

Back then, she recalls being told: “At the end of the day, you can guarantee your hair will grow back but not your life, as hard as it may sound.”

Today, she has contributed to offering the chance for patients not to lose their hair in the first place, and it is her work to improve their lives that “keeps me alive”, she said as she prepares for a “big fest “on October 12.

The ABCF event aims to continue to raise funds for initiatives like these and Sant urges the public to attend and participate in the various activities in Buġibba Square, complete with exercise, DJs and activities for children.