If you’re about to start Eribulin chemotherapy, losing your hair may be one of the things you’re worrying about most.

For some people, hair loss feels like a small part of cancer treatment. For others, it feels enormous. Your hair can be tied up with your identity, confidence and privacy, and you may simply want to look like yourself for as long as possible.

Eribulin can cause hair loss, although the amount varies from person to person. A 2016 clinical review reported hair loss in 35% to 45% of patients across two Eribulin breast cancer trials, showing that it is common, but not inevitable.

Cold capping, also known as scalp cooling, is used to help reduce chemotherapy-related hair loss in suitable patients, but there is limited published evidence looking specifically at how effective it is with Eribulin.

That does not necessarily mean cold capping is not an option. It simply means we cannot give you a reliable Eribulin-specific success rate from the published evidence available.

In this guide we’ll explain:

• What is Eribulin chemotherapy?
• How likely is it to cause hair loss?
• How cold capping works
• What can you realistically expect?
• How do you use Penguin Cold Caps?
• How do you care for your hair during treatment?
• What to think about before your first chemotherapy session

What is Eribulin Chemotherapy?

Eribulin, also known by the brand name Halaven®, is a chemotherapy drug used to treat certain types of cancer.

In the US, the National Cancer Institute says it is approved for some people with metastatic breast cancer who have already received previous chemotherapy, as well as some people with unresectable or metastatic liposarcoma. Eribulin works by interfering with the way cancer cells divide and grow.

Your treatment schedule will depend on your diagnosis and individual treatment plan, and your oncology team will explain what applies to you.

Does Eribulin cause hair loss?

Hair loss is one of the recognised side effects of Eribulin, but it doesn’t affect everyone in the same way. Some people notice gradual thinning, while others lose much more of their hair during treatment.

A 2016 review reported 35% to 45% hair loss across two studies, showing that it is common, but not inevitable. Unfortunately, it is not possible to know exactly how your hair will respond before treatment begins.

Chemotherapy affects cells that divide quickly. That includes cancer cells, but also the cells involved in hair growth. This is why chemotherapy can cause hair to thin or fall out. The amount of hair loss can depend on the chemotherapy drug, the dose and how it is given.

For many people, the uncertainty is one of the hardest parts. You may have been told that hair loss is possible without really knowing what that will mean for you personally.

That is often where cold capping comes into the conversation.

Can you cold cap with Eribulin?

Cold capping may be an option for some people receiving Eribulin, but whether it is suitable for you will depend on your diagnosis, treatment plan and individual circumstances. We recommend checking with your oncology team before you begin.

Cold capping has helped reduce chemotherapy-related hair loss for many patients, although results vary and it may not be suitable for everyone.

What we cannot say is that cold capping has been proven to work at a particular rate with Eribulin. Published evidence specifically looking at Eribulin and cold capping is limited, so there is no reliable success percentage we can quote. That is important because we would rather be realistic with you than make promises that cannot be backed up.

If keeping your hair is important to you, however, it is still worth speaking to us about your treatment. We can explain how Penguin Cold Caps are used, what is involved and how to prepare for treatment.

We will also always recommend checking with your oncology team before starting cold capping.

What can I realistically expect?

Probably the most important thing to understand before cold capping is that no scalp cooling system can guarantee that you will keep all of your hair.

Some people retain a large proportion of their hair. Others experience noticeable thinning or shedding.

How well cold capping works can depend on several things, including:

• the chemotherapy drug and dose
• your individual response to treatment
• the condition of your hair and scalp before chemotherapy
• how closely the cap fits
• how consistently the cooling schedule is followed

It can help to think of cold capping as a way of trying to reduce hair loss, rather than expecting to come through chemotherapy without losing any hair at all.

For many people, even retaining enough hair that they still recognise themselves in the mirror can make a meaningful difference.

How does cold capping help protect your hair?

Cold capping is designed to reduce the effect of chemotherapy on the hair follicles in your scalp. It works by cooling your scalp before, during and after chemotherapy.

When your scalp becomes cold, the small blood vessels beneath the skin narrow. This may reduce the amount of chemotherapy reaching the hair follicles and can help protect hair follicle cells from chemotherapy damage and reduce hair loss.

How do Penguin Cold Caps work?

Penguin Cold Caps are a manual scalp-cooling system used before, during and after chemotherapy.

The caps are frozen before treatment and changed regularly so that your scalp stays consistently cold. You will usually need someone with you to help change the caps during treatment.

Cold capping can feel very cold at first, and some people experience a headache or pressure from the cap. Some people find the initial discomfort becomes easier once they settle into the treatment. Your Penguin specialist can explain what to expect and how to prepare.

If you choose Penguin Cold Caps, we will explain:

• how to prepare your hair
• when cooling needs to start
• how often the caps should be changed
• how long you need to continue cooling after chemotherapy
• what you will need on treatment day

Knowing what to expect beforehand can make the whole process feel much more manageable.

Will I still lose some hair?

Quite possibly. Some shedding can happen even when cold capping is helping.

This is something that can catch people by surprise. You may see more hair than usual in the shower or on your brush and immediately think the cold cap is not working.

That is not necessarily the case.

Cold capping is about reducing hair loss rather than guaranteeing none at all. Some people continue shedding throughout treatment but still retain enough hair that they are pleased they chose to cold cap.

If you are worried about the amount you are losing, speak to your Penguin Cold Caps specialist. They can talk through what you are experiencing and help you understand whether anything about your cap fit or routine needs checking.

How should I look after my hair while cold capping?

Your hair can become more fragile during chemotherapy, so this is a time to treat it as gently as possible.

You do not need to become frightened of touching or washing your hair, but it is worth avoiding anything that puts unnecessary stress on it.

You may want to:

• wash your hair gently
• avoid very hot water
• use mild shampoo and conditioner
• pat rather than rub your hair dry
• avoid straighteners, curling irons and other high-heat styling
• avoid bleaching and harsh chemical treatments
• brush or comb carefully
• avoid tight ponytails or styles that pull at the roots

What if I still lose more hair than I hoped?

This is worth thinking about before treatment starts. Cold capping can give you a chance of keeping more of your hair, but it cannot guarantee the outcome.

If you do experience heavier shedding, that does not mean you have done anything wrong.

Some people decide they still want to carry on because they are retaining enough hair for cold capping to feel worthwhile. Others decide that the extra time and effort are no longer right for them.

Either decision is fine.

You may also want to think about having a backup plan, such as choosing a wig or buying a few scarves or hats before treatment starts. You may never need them, but having them ready can make you feel a little more prepared.

Will my hair grow back after Eribulin?

For most people, chemotherapy-related hair loss is temporary. Hair usually begins to grow again after treatment ends, although it can take time, and the new growth may initially look or feel different.

It may come back a slightly different colour or texture at first. That can feel strange, but your hair may continue to change as it grows.

What other side effects can Eribulin cause?

Everyone responds differently to chemotherapy. Some people experience relatively mild side effects, while others find treatment more difficult.

Your oncology team will monitor you throughout treatment and can recommend medication or supportive care to help manage many of these side effects.

Alongside hair loss, possible side effects of Eribulin can include:

• Fatigue
  Feeling tired is common during chemotherapy and may become more noticeable as treatment continues. Try to pace yourself and allow time to rest when you need it.
• Increased risk of infection
  Eribulin can lower your white blood cell count, which can make it harder for your body to fight infection. Your treatment team will explain which symptoms need urgent attention and who to contact if you feel unwell.
• Nausea
  Some people feel sick during treatment, although anti-sickness medication can help. Tell your oncology team if nausea becomes difficult to manage.
• Constipation
  Eribulin can cause changes in your bowel habits, including constipation. Your healthcare team can recommend ways to help manage this.
• Numbness or tingling in the hands and feet
  Eribulin can affect the nerves and cause tingling, numbness or discomfort, particularly in the hands and feet. Let your treatment team know if you notice any new symptoms.
• Loss of appetite
  You may find that your appetite changes during treatment. Eating smaller meals more often can sometimes make this easier to manage.
• Muscle or joint pain
  Some people experience aching muscles or joints while receiving Eribulin.

This is not a complete list of possible side effects. Always speak to your oncology team if you have any symptoms that worry you or if you feel unwell during treatment.

Preparing for your first Eribulin treatment

If you are thinking about cold capping, try not to leave everything until the morning of your first chemotherapy session.

Once you know your treatment plan, you can speak to us about whether Penguin Cold Caps may be suitable and what will be involved.

Before treatment begins, it is useful to know:

• when you need to start cooling
• how long you will need to cool afterwards
• how many caps you need
• who will help you change them
• how to prepare your hair
• what to take with you on treatment day

You should also check with your oncology team that they are happy for you to use cold capping with your treatment.

A little preparation can make your first treatment day feel much less overwhelming.

Our Cold Capping Specialists can talk to you about your Eribulin treatment, explain how Penguin Cold Caps work and answer any practical questions you have about getting started.

We cannot promise exactly how much hair you will keep, but we can help you understand what cold capping involves and give you the information you need to decide whether you would like to try it.