Scalp cooling to help prevent hair loss

Learn about 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 oncologyinfo-icon at Johns Hopkins, in conversation with Living Beyond Breast Cancer CEO Jean Sachs, MSS, MLSP.

What scalp cooling does

Scalp cooling is a therapyinfo-icon that helps some people lose less or no hair during chemotherapyinfo-icon treatment. Though 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 treatment session slows blood flow to the scalp so that it is exposed to less chemotherapy. This is done by wearing a cooled cap during chemotherapy infusions. Usually, you wear the cap 30 minutes before the infusioninfo-icon starts to bring the temperature of your scalp down and leave it on after the infusion ends for a length of time recommended by the company that makes the equipment you use.

Types of scalp cooling

There are two of methods of scalp cooling available today:

  • Refrigerated scalp cooling systems (machine based)
  • Cold caps

Refrigerated scalp cooling systems keep the cap cold throughout your treatment session. The cap has channels built into it to circulate a coolant through the cap and a nearby machine to keep the coolant consistently cold. This kind 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 with the help of staff or you may have to place the cap yourself. So far, the FDAinfo-icon has cleared two refrigerated scalp cooling systems.

Cold caps are another method of scalp cooling therapy. You can rent the caps directly from the company that makes them. These usually come with multiple caps that you keep in a cooler on dry ice. You bring the caps to each treatment. During a chemotherapy infusion session, you’ll need to change caps about every 30 minutes, replacing the one you are wearing, which has warmed up, with a cold one from the dry ice cooler. Many people find it helpful to bring a friend or family member to treatment to help them place and change the caps correctly.

Who scalp cooling works for

Research shows that scalp cooling works in some cases, but not in others. In the SCALP trial,  half the participants reported the Paxman Scalp Cooling System was “successful” in those who used it. But there was a large difference in success depending on which chemotherapy medicineinfo-icon a person was given. In this trial, scalp cooling was successful in 59 percent of people given taxaneinfo-icon-based chemotherapy and only 16 percent of people given an anthracyclineinfo-icon. 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.

Personal factors, such as your hair type and age, may affect how well scalp cooling works for you, but the effects of these personal 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.

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 and listen closely to 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 nauseainfo-icon. 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 from 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 recurrenceinfo-icon or metastaticinfo-icon breast cancer. There is no research evidence that this happens, and a recent analysis of multiple studies with over 3,000 people found no difference in the rates of metastasisinfo-icon to the scalp between those who used scalp cooling and those who did not.

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 determine if scalp cooling may be right for you, visit Paxman's scalp cooling Decision Making Guide

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July 15, 2021