Prema P. Peethambaram, MD, is a medical oncologist and Associate Professor of Oncology at the Mayo Clinic in Rochester, Minnesota. She has a passion for treating women’s cancers and providing compassionate cancer care.
Charles L. Loprinzi, MD, FASCO, is the Regis Professor of Breast Cancer Research at the Mayo Clinic in Rochester, Minnesota, where he is an emeritus chair of the Division of Medical Oncology and an emeritus vice-chair of the Department of Oncology. He is also the Cancer.Net Associate Editor for Psychosocial Oncology.
Ashley* had breast cancer and needed several rounds of chemotherapy to improve her chance of being cured. Her oncologist described the potential side effects, including hair loss. Ashley didn’t want her colleagues to know she had cancer, and she worried that losing her hair would make it obvious. She shared this concern with her oncologist, who talked with her about trying to prevent hair loss with scalp-cooling therapy. Fortunately for Ashley, the therapy worked. She didn’t lose significant amounts of hair—or her privacy—during her chemotherapy treatments.
Could this story be possible? Yes. By cooling the scalp, scalp blood vessels narrow, which results in less chemotherapy reaching the hair follicles. In addition, cooler hair follicles become inactive, making them less susceptible to the treatment. The result can be reduced hair loss.
Over 30 clinical trials have been conducted since the 1970s regarding the effectiveness and safety of scalp-cooling therapy. Since 2015, the U.S. Food and Drug Administration (FDA) has approved 2 different scalp-cooling therapy systems for chemotherapy-induced hair loss: DigniCap and Paxman.
How do scalp-cooling systems work?
For decades, various methods have been tried to cool the scalp. Until recently, the most common one has been putting on frozen caps that had been kept in dry ice. This approach requires that the caps be changed every 20 to 30 minutes during chemotherapy. The repeated impact of the ice-cold caps on the scalp can be uncomfortable for some people. In addition, an assistant is needed to help with cap changes, and patients may have to bring a large container of dry ice with them to their chemotherapy treatment to keep the caps cold.
Today, the most common scalp-cooling systems are easier to manage and more effective than the frozen cap process. Clinical trials have shown that the FDA-approved systems are tolerated well by most people and decrease hair loss caused by chemotherapy. The systems allow for a slower cooling of the scalp, by circulating cold fluid through channels in a cap that’s fitted to the patient. The temperature of the coolant is monitored and kept within the needed temperature range. Using a scalp-cooling system will extend the patient’s time at the center or clinic. Scalp cooling needs to start at least 30 minutes before the chemotherapy infusion starts. The cooling continues during chemotherapy and for up to 90 minutes after the infusion is completed.
What has research shown about scalp cooling?
The overall reported success rate of scalp-cooling therapies is 50% to 80%. This reported success rate does not mean that scalp cooling completely stops hair loss. It means that a patient has less than 50% hair loss, which usually means that there is enough remaining hair so the person does not feel the need to use a wig or hair covering. Results also vary depending on the type and dosage of the chemotherapy, so ask a member of your health care team what you can expect. It’s important for people to be fitted with the correct size cap and to follow hair care instructions carefully during chemotherapy.
Who can use scalp cooling?
Scalp cooling is currently approved for women and men of any age being treated with chemotherapy for most cancers. However, scalp cooling isn’t recommended if you have leukemia or other certain blood-related cancers.
Most people can use it with few side effects. Common side effects are headaches and feeling cold. If cold temperatures really affect you, then the therapy may not be right for you. Talk with your doctor about any questions you may have about hair loss and scalp cooling before and during treatment.
Where can someone get scalp cooling?
Over the last few years, scalp-cooling therapy has become more available at cancer centers. As of now, insurance does not generally cover the cost of this therapy to prevent hair loss but check with your insurance provider. There are also patient advocacy organizations, such as HairToStay and the Rapunzel Project, that are working to expand patients’ access to it.
*This story is a composite of many stories from people with cancer.