Scalp Cooling (Scalp Hypothermia)
How does chemotherapy cause hair loss?
Chemotherapy attacks cells in our body that grow and multiply quickly, like cancer cells. Some normal cells grow quickly, like hair cells, and are also affected by chemotherapy. The damage to these normal cells causes hair loss (also called alopecia). The types of chemotherapy that most often cause alopecia are taxanes, anthracyclines, and alkylating medications. About 65% of people getting chemotherapy will lose some or all of their hair. Keep in mind, not all cancer medicines cause alopecia.
What is scalp cooling (scalp hypothermia)?
Your scalp is the soft skin that goes from the top of your face near your forehead, down the back of your head, to the beginning of the back of your neck. Hypothermia means lowering your body temperature, so that is it cool or cold. Scalp cooling uses cold caps or ice packs to lower the temperature of your scalp. Scalp cooling may be used before, during, and after your chemotherapy treatments. The goal of scalp cooling is to stop your hair from falling out.
How does scalp cooling work?
When things are cold, they get smaller (constrict), or tighten. Cooling the scalp during treatment constricts the blood vessels that go to your scalp. This lessens how much chemotherapy gets to your scalp and into the hair cells. If the chemotherapy does not get to your scalp and hair cells, you may have less alopecia.
Who can use scalp cooling?
The most common use of scalp cooling is with patients who have breast or ovarian cancer. You are not able to use scalp cooling if:
- You have a blood cancer, like leukemia or lymphoma.
- You are sensitive to cold, or have cryoglobulinemia, cryofibrinogenemia, or cold urticaria.
- You have central nervous system (CNS) problems.
- You have head and neck cancer or small cell cancer of the lung, or if your cancer has spread to your scalp.
- If you are getting or have had radiation therapy to the brain.
- You are going to need treatment with a chemotherapy that wipes out your bone marrow (for a transplant).
Ask your care team if scalp cooling is right for you.
What kinds of scalp cooling are there?
Scalp cooling has been used since the 1970s, in different ways. Patients once used frozen vegetables and ice packs. Newer systems use a computer to control the cooling of the cap. Two of these systems (Paxman and DigniCap) have been approved by the Food and Drug Administration (FDA) to be used in the United States. The cap is connected to a small refrigeration (cooling) system. A coolant fluid is pushed through the cold cap, lowering your scalp temperature. The constant flow of this coolant fluid keeps your scalp at a constant temperature during your treatment.
What does scalp cooling look like?
Scalp cooling systems use computers to control the temperature. You will have a cap that is fitted to your head. Some treatment centers have a machine and someone to help you use it.
- You may get fitted for your own personal cap ahead of your treatment. Once you put that cap on, a tighter neoprene/stretchy cap will be placed on top of your cap. This is to keep the coldness as close to your scalp as possible.
- You will need to “pre-cool” your scalp before your infusion of chemotherapy. You will start the cooling process about 30 minutes before your infusion.
- You will wear the cap throughout the whole infusion.
- You will wear the cap for 90 minutes after your infusion is done.
- You will stay seated for at least 5 minutes after the cap is removed so that your scalp can return to room temperature.
What are the side effects of scalp cooling?
There are some possible side effects of scalp cooling:
- Feeling intense cold.
- Neck, shoulder, or scalp pain.
- Feeling dizzy.
- Stiffness/boredom from having to remain seated while you are connected to the cold cap.
There are concerns that scalp cooling leads to cancer cells not being destroyed. Studies have not supported this. Talk with your provider if you have questions or concerns about this.
How much does scalp cooling cost?
Older types of scalp cooling caps are often not covered by insurance. Not all insurance companies cover scalp cooling. Medicare and Medicaid (CMS) covers some uses of scalp cooling. If it is not covered, you will have to pay for it. The price for scalp cooling treatment should be explained before you decide if it is right for you.
Does scalp cooling work?
Although scalp cooling has been used for over 30 years, the newer systems being used still need more testing and research to find out how well they work. Most studies have found that scalp cooling prevents significant hair loss on the head in about 40-50% of people. This means that about half of the people using scalp cooling kept at least 50% of their hair. These systems seem to work best for patients who receive taxane chemotherapy medications.
Scalp cooling does not stop hair loss in other areas, such as eyebrows, eyelashes, and in other areas of the body.
American Cancer Society. Cooling Caps (Scalp Hypothermia) to Reduce Hair Loss. (2020). Retrieved from oncoluhttps://www.cancer.org/treatment/treatments-and-side-effects/physical-side-effects/hair-loss/cold-caps.html
M.Martin et al. Persistent major alopecia following adjuvant docetaxel for breast cancer: incidence, characteristics, and prevention with scalp cooling. Breast Cancer Research and Treatment (2018) 171:627-634.
NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Ovarian Cancer V.1 2020. Retrieved from https://www.nccn.org/patients/guidelines/content/PDF/ovarian-patient.pdf
Peterson, L. L., Lustberg, M., Tolaney, S. M., Ross, M., Salehi, E., & Isakoff, S. J. (2020). Integration of Physician and Nursing Professional Efforts to Deliver Supportive Scalp Cooling Care to Oncology Patients at Risk for Alopecia. Oncology and therapy, 8(2), 325–332. https://doi.org/10.1007/s40487-020-00120-6
Weatherby, L., & Brophy, L. (2019). Scalp Cooling: A Patient's Experience. Journal of the advanced practitioner in oncology, 10(2), 158–165.