Cold Capping and AC Chemotherapy

If you’ve recently been diagnosed with breast cancer or another type of cancer, your oncologist may have recommended an AC chemotherapy regimen. One of the man side effects of this type of chemo is hair loss, which many people find distressing.

This article focuses on AC chemotherapy, the associated side effects, and what patients of AC can do to mitigate these symptoms, including hair loss.

What is AC?

AC stands for Adriamycin (Doxorubicin) and Cyclophosphamide (Cytoxan), a combination of drugs often prescribed for treating breast cancer, particularly in early-stage or locally advanced cases. The AC regimen is designed to target and destroy cancer cells, helping to prevent the cancer from returning.

The AC chemotherapy regimen combines two powerful drugs: Adriamycin (Doxorubicin) and Cyclophosphamide (Cytoxan). Adriamycin is an anthracycline that interferes with cancer cell DNA, preventing it from replicating and leading to cell death. Cyclophosphamide is an alkylating agent that damages the DNA of cancer cells, making it difficult for them to divide and grow. Together, these drugs create a robust anti-cancer regimen that is highly effective in treating breast cancer and other types of cancer, such as ovarian cancer and lymphoma.

AC is often used as a part of a broader treatment plan that may include surgery, radiation, and/or additional chemotherapy. It’s crucial to understand that every cancer journey is unique, and your healthcare team will tailor your treatment plan to offer the best possible outcome for your specific diagnosis.

A Typical AC Treatment Plan

AC chemotherapy is usually administered in cycles, with each cycle lasting 21 or 28 days. During each cycle, you receive the chemotherapy drugs on the first day, followed by a rest period that allows your body to recover. A standard AC regimen often consists of four to six cycles, although the number of cycles may vary based on your specific case and how well your body tolerates the treatment.

Administration Methods:

• Cannula: A small tube inserted into a vein, typically in the arm or hand, through which the drugs are delivered.
• Central Line: A tube placed into a large vein, often in the chest.
• PICC Line: A longer tube inserted into a vein in the arm that reaches a larger vein near the heart.
• Implantable Port (Portacath): A small device placed under the skin, usually on the chest, that allows easy access to a vein.

Before each treatment, you will have blood tests to ensure your body is ready to receive chemotherapy. It’s essential to communicate with your healthcare team about any side effects or concerns, as they can adjust your treatment plan to better suit your needs.

The Common Side Effects of AC Chemotherapy

AC chemotherapy is a potent treatment, and while effective, it can cause several side effects. These effects can vary in intensity, but being prepared can help you manage them better. Here are the common side effects of AC chemotherapy:

• Hair Loss: One of the most common and visible side effects of AC chemotherapy is hair loss. This can affect not only the hair on your head but also your eyebrows, eyelashes, underarms, legs, and even pubic hair. Although hair generally regrows after treatment, it may come back softer, curlier, or a different color. However, there are effective ways to manage hair loss and maintain your self-esteem during treatment. Scalp cooling, or “cold capping,” has emerged as a supportive technique for many. Wearing a special cap cooled with gel during chemotherapy sessions can significantly reduce blood flow to the scalp, helping to minimize hair loss. The Penguin cold cap is one example that has benefitted numerous patients.
  Explore more about this technique: What is cold cap therapy?
• Increased Risk of Infection (Neutropenia): Chemotherapy can lower your white blood cell count, weakening your immune system and making you more prone to infections. Symptoms might include a change in temperature, aching muscles, headaches, or feeling cold and shivery. Depending on the infection’s location, other symptoms may also appear. Since infections can sometimes be serious, it’s important to contact your healthcare team immediately if you suspect an infection.
• Breathlessness: A decrease in red blood cells can lead to anemia, which may cause you to feel breathless and look pale. This can also make you feel more tired than usual.
• Increased Risk of Bruising and Bleeding: A reduction in platelet count can make it easier for you to bruise or bleed. You may experience nosebleeds, bleeding gums when brushing your teeth, or notice small red spots or bruises (petechiae) on your skin, particularly on your arms or legs.
• Bladder Inflammation (Cystitis): AC chemotherapy can irritate the bladder, leading to symptoms like frequent urination, difficulty urinating, or a burning sensation when you go. You might also feel an urgent need to urinate. Drinking plenty of fluids can help, but avoid over-the-counter cystitis treatments and consult your healthcare team instead.
• High Temperature (Fever): A high temperature or fever can occur after treatment. Report any fevers to your healthcare team immediately.
• Chills or Shivering: Experiencing chills or shivering is another possible side effect. Let your healthcare team know if you encounter these symptoms.
• 30 to 50% of people experience loss of appetite : Various factors, such as nausea, taste changes, or fatigue, can lead to a loss of appetite during chemotherapy. Eating small, frequent meals and staying hydrated can help.
• Nausea and Vomiting: Nausea and vomiting are common but can be managed with anti-sickness medications. Taking these medications as prescribed and avoiding fatty or fried foods may help keep symptoms under control.
• Sore Mouth and Mouth Ulcers: Chemotherapy can cause mouth sores and ulcers, which can be painful. Keeping your mouth clean, staying hydrated, and avoiding acidic foods can help reduce discomfort. Chewing gum might also help keep your mouth moist.
• 10 to 30% of people experience diarrhea: If you experience diarrhea (e.g., two or more loose bowel movements in a day), contact your healthcare team. They can provide anti-diarrheal medications if needed. Maintaining a balanced diet and staying hydrated is also important.
• 20 to 30% experience changes to skin and nails: Your skin, especially on your hands and feet, may become red, sore, or start peeling—a condition known as hand-foot syndrome. Your skin might also become more sensitive to light or develop rashes. Nails can change color or separate from the nail bed. Regular moisturizing and discussing appropriate skin care with your healthcare team can help manage these changes.
• 80 to 90% of people report tiredness and weakness: Fatigue is common during and after chemotherapy. Gentle daily exercises can help maintain your energy levels, but listen to your body and rest when needed. Don’t hesitate to ask for help with daily tasks.
• 5 to 10% of people say AC has impacted their heart function. Your doctor will likely conduct tests before, during, and after treatment to monitor your heart health.
• 5 to 15% have mild liver changes: But they are typically temporary and resolve after treatment ends. Regular blood tests will help monitor your liver function throughout treatment.
• Weight Gain: Some patients experience weight gain during chemotherapy. Maintaining a healthy diet and staying active can help manage this. If you find it difficult to control your weight, talk to your healthcare team for guidance.
• Inflammation Around the Drip Site: If you notice pain, redness, swelling, or leaking around the chemotherapy drip site, inform your nurse immediately.

These side effects can vary in severity, so it’s crucial to stay in close contact with your healthcare team during treatment. They can offer guidance and medications to help manage any symptoms you experience.

Fertility, Pregnancy, and Breastfeeding During AC Chemotherapy

Fertility: AC chemotherapy can affect fertility in both men and women. Women may experience changes in their menstrual cycle or early menopause, while men may have a reduced sperm count. If you are planning to have children in the future, discuss fertility preservation options with your doctor before starting treatment.

Pregnancy: Chemotherapy can harm an unborn baby, so it’s crucial to use effective contraception during treatment and for some time afterward. If you become pregnant while on AC chemotherapy, inform your doctor immediately.

Breastfeeding: Breastfeeding is not recommended during AC chemotherapy, as the drugs can be passed to the baby through breast milk. You should also avoid breastfeeding for some time after completing treatment, as recommended by your healthcare provider.

Managing Hair Loss During AC Chemotherapy

Hair loss is one of the most distressing side effects of AC chemotherapy for many patients. However, there are options to help manage and potentially reduce hair loss.

Why Does Chemotherapy Cause Hair Loss?

Chemotherapy targets rapidly dividing cells, which includes cancer cells. Unfortunately, hair follicles are also rapidly dividing cells, making them vulnerable to the effects of chemotherapy. This can lead to hair thinning or complete hair loss during treatment.

Is It Possible to Prevent Hair Loss?

While hair loss is common with AC chemotherapy, scalp cooling, also known as cold capping, has been shown to reduce hair loss in some patients. Cold capping works by cooling the scalp, which constricts blood vessels and reduces the amount of chemotherapy drug that reaches the hair follicles.

How Does Cold Capping Stop Hair Loss?

Cold capping involves wearing a specialized cap filled with a cooling gel during chemotherapy treatments. The cap is chilled to a very low temperature and worn before, during, and after the chemotherapy session. The cold temperature causes blood vessels in the scalp to constrict, limiting the amount of chemotherapy that reaches the hair follicles.

• Vasoconstriction: The cold temperature causes blood vessels in the scalp to narrow, reducing blood flow to the area.
• Reduced Chemotherapy Drug Exposure: With less blood flow, the hair follicles are exposed to a lower concentration of chemotherapy drugs, helping to preserve them.
• Preservation of Hair Follicles: By reducing the exposure of hair follicles to chemotherapy, cold capping can help minimize hair loss.

The effectiveness of cold capping can vary depending on factors such as the type and dosage of chemotherapy and individual patient characteristics. However, many patients report significant hair retention with cold capping.

For more information see our article: Will cold capping save my hair on chemo?

Penguin Cold Caps make the process of cold capping simple

If you want to learn more our article: What to expect on the day

Penguin Cold Caps Success with AC Patients

Penguin Cold Caps is a leading provider of cold cap therapy, helping thousands of patients undergoing chemotherapy, including those on the AC regimen, to preserve their hair. Many patients who have used Penguin Cold Caps report minimal hair loss, allowing them to maintain their appearance and self-esteem during treatment.

Patient Success Stories

Penguin Cold Caps Clinical Evidence

The effectiveness of cold cap therapy is supported by clinical research. Studies have shown that cold capping can significantly reduce hair loss in patients undergoing chemotherapy, including the AC regimen. This evidence, combined with countless patient testimonials, demonstrates that cold capping is a viable option for those looking to preserve their hair during treatment.

To find out more about see: The evidence that cold cap therapy works.

Finding a Support Network

Navigating AC chemotherapy can be challenging, both physically and emotionally. Finding a strong support network can make a significant difference in your treatment journey. This support can come from family, friends, support groups, or online communities.

Support Groups: Joining a support group can provide a sense of community and understanding during your cancer journey. Many cancer centers offer in-person support groups where you can connect with others who are going through similar experiences.

Social Media Groups: Additionally, online forums, such as the Chemotherapy Support Group on Facebook, offer a convenient platform to share your feelings, ask questions, and receive advice from others facing similar challenges. Engaging with a support group can help you feel less isolated, provide emotional comfort, and give you practical tips for managing side effects and navigating treatment.

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