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Scalp cooling to help prevent hair loss

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Learn about scalp cooling — what it is, how it works, and who it can help — in this video featuring Vered Stearns, MD, director of the Women’s Malignancies Disease Group and professor of oncology at Johns Hopkins, in conversation with Living Beyond Breast Cancer CEO Jean Sachs, MSS, MLSP.

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What scalp cooling does

Scalp cooling is a therapy that helps some people lose less or no hair during chemotherapy treatment. Although wigs, scarves, and hats offer affordable and fashionable ways to cover hair loss, many people prefer to prevent losing their hair during treatment.

There are a few different scalp cooling systems available in the United States, but the way they work to prevent hair loss is similar: Cooling the scalp and hair follicles during a chemotherapy infusion session slows blood flow to the scalp so that it is less exposed to chemotherapy. Wearing a scalp-cooling cap can slow chemo’s ability to affect the hair follicles. People who use scalp cooling systems usually put the cap on 30 minutes before the infusion starts, and continue to wear it throughout the infusion and for some time after it ends. How long a person wears the cap after the infusion is over depends on what the equipment manufacturer recommends. One example is 90 minutes.

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Types of scalp cooling

There are two of methods of scalp cooling available today:

  • Refrigerated scalp cooling systems
  • Cold caps

Refrigerated scalp cooling systems use a refrigeration unit to keep the cap cold throughout your treatment session. The unit has coolant inside that connects to the cap through a line and circulates through channels inside the cap to keep your scalp cold. This type of scalp cooling usually requires the cancer center to have one of these systems in their infusion rooms. Depending on the machine used and the policies of your treatment center, you may have the cap placed on your head with the help of staff or you may have to place the cap yourself.

Cold caps are another method of scalp cooling. These caps can be rented directly from the manufacturing company. With this method, multiple caps are kept in a cooler on dry ice. You bring the cooler of caps to each chemo infusion session. During the session, the cap stays cool on your head for about 30 minutes. When it warms up, you’ll need to switch the cap on your head with a cold one from the cooler. Many people find it helpful to bring a friend or family member to treatment to help them place and change the caps correctly.

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Does scalp cooling work for everyone?

Research shows that scalp cooling works in some cases, but not in others.

In the SCALP trial, half the participants using it reported that the Paxman Scalp Cooling System was “successful.” But there was a large difference in success depending on which chemotherapy medicine a person was given. In this trial, scalp cooling was successful in 59 percent of people given taxane-based chemotherapy and only 16 percent of people given an anthracycline. A similar trial using the DigniCap system found scalp cooling was successful in 66 percent of participants, but that study did not include anyone given anthracycline chemotherapy. Higher doses of chemotherapy were also linked to lower rates of success with scalp cooling.

Even when scalp cooling was successful, most people lost some hair, but enough of their own hair remained so that they did not need a wig. The studies defined success as either “not needing a wig” or keeping at least 50 percent of their hair after chemotherapy.

Individual factors, such as your hair type and age, may affect how well scalp cooling works for you, but the effects of these factors have not yet been established in studies. Many companies and experts say to avoid dyeing, waving, and using other harsh processes in your hair during treatment. Beyond these recommendations, there is little agreement about how to care for your hair. There are no studies that show the effect hair care methods have on the success of scalp cooling.

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Side effects and things to remember

Using the cooling cap or refrigerated system correctly is important to improving the chances that you will benefit from scalp cooling. This includes making sure the cap is on correctly. Make sure to follow all directions from the manufacturer as well as the instructions at the infusion site if you are using their system.

Scalp cooling often causes side effects. The most common reported are headache, feeling cold, and nausea. Some people also find using the cold cap to be uncomfortable, but most people do not stop using the caps because of discomfort. Reported rates of stopping scalp cooling due to side effects range from 3 percent to 12 percent.

Some people also worry that slowing the flow of chemotherapy to the scalp will raise the risk of breast cancer cells traveling to the scalp, causing a recurrence or metastatic breast cancer. There is no research evidence that this happens. An analysis of multiple studies involving over 3,000 participants found no difference in the rates of scalp metastasis in people who used scalp cooling versus people who didn’t.

Scalp cooling is not covered by most insurance companies. To use one of the refrigerated scalp cooling systems, you may have to pay for a personal cap plus a per-session fee, with totals that range from $1,500 to $3,000. Rented cold caps can cost about $500 per month. Some organizations, such as Hair to Stay, offer assistance to people who have financial need.

To figure out whether scalp cooling may be right for you, visit Paxman's scalp cooling Decision Making Guide.

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Reviewed and updated: August 26, 2022

Reviewed by: Mikel Ross MSN, RN, AGPCNP-BC, OCN, CBCN

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Living Beyond Breast Cancer is a national nonprofit organization that seeks to create a world that understands there is more than one way to have breast cancer. To fulfill its mission of providing trusted information and a community of support to those impacted by the disease, Living Beyond Breast Cancer offers on-demand emotional, practical, and evidence-based content. For over 30 years, the organization has remained committed to creating a culture of acceptance — where sharing the diversity of the lived experience of breast cancer fosters self-advocacy and hope. For more information, learn more about our programs and services.

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