An Overview of Scalp Cooling

Scalp cooling (also referred to as scalp hypothermia) involves using ice packs or a cooling cap before, during, and after a chemotherapy to prevent or drastically reduce hair loss. Certain chemotherapy drugs are known for inducing hair loss, and this treatment may be a solution for some patients.

Why Chemo Causes Hair Loss

Chemotherapy drugs target cells that multiply and divide very quickly, as these are the traits of cancer cells. While useful for this purpose, the treatment is not targeted. In other words, it acts on the whole body, not just the tumor site. In addition, because chemotherapy targets all dividing cells without discretion, it can affect cells that are healthy—not just those that are malignant.

Hair cells fall into this group, which means that their destruction—and hair loss—ends up being an unwanted consequence of chemotherapy treatment.

How Scalp Cooling Works

There are two ways to approach scalp cooling. The first is a cooling cap, which is a snug, helmet-style hat that is filled with a gel coolant and chilled to between -15 and -40 degrees F. The cooling cap will narrow the blood vessels under the scalp, which helps reduce the amount of chemotherapy medication that reaches hair follicles and cells.

Similar to an ice pack, cooling caps gradually thaw during treatment as they are being worn by the patient. As a result, roughly every 30 minutes, the cap needs to be replaced.

The second way to approach scalp cooling is by using a scalp cooling system, which became available in 2016. There are currently two scalp cooling systems approved by the U.S. Food and Drug Administration (FDA): the DigniCap Scalp Cooling System and the Paxman Scalp Cooling System.

These systems work the same way a cooling cap does, but they offer the benefit of a cap that is attached to a refrigeration unit. This delivers coolant to the scalp continuously; there’s no need to change the cap once it’s on.

Frequency

If you and your healthcare provider decide that scalp cooling is an option for you, you’ll wear a cooling cap or connect to a scalp cooling system beginning 20 to 50 minutes before chemotherapy treatment, during the entirety of the chemotherapy session, as well as for roughly 20 to 50 minutes after treatment.

One of the benefits of using a cooling cap versus a system is that it’s portable, so you’ll be able to leave the treatment center and finish up your scalp cooling on the drive home.

The Cost

Most insurances don’t cover scalp cooling, though, depending on your specific plan, you may be able to be reimbursed for the cost. You can, however, use a flexible savings account or health savings account to help pay for scalp cooling treatment.

Cooling cap prices depend on the manufacturer and can be found by visiting their website. (Just keep in mind you’ll need more than one cap to swap out during treatments.)

If you use a scalp cooling system, the price will depend on how many treatments you need and may range from $1,500 to $3,000. Since you’ll likely be using a facility's cooling system, you will also be charged a facility fee, which is around $60 to $70 per treatment and not covered by insurance.

There are also a few nonprofits dedicated to help cancer patients receive scalp cooling treatments, such as The Rapunzel Project and the Hair to Stay Foundation.

Effectiveness

Research published in the March 2018 edition of the Journal of Oncology Practice found that, depending on the type of chemotherapy drugs used, scalp cooling could be extremely beneficial.

For example, one study reports that women using a Paxman cooling system who had different types of chemotherapy (from taxane-based to an anthracycline) kept anywhere from 16% to 59% of their hair. Women who were treated with Taxol kept 100% of their hair.

Researchers also looked into the DigniCap system and found that those treated with taxane-based chemotherapy kept 66% of their hair, and 100% if their treatment was weekly Taxol. In the instance of cooling caps, taxane-based chemotherapy had a success rate of 50% to 84% of hair retained, while women with anthracycline-based chemotherapy kept 20% to 43% of their hair.

Side Effects

Side effects of scalp cooling include headaches, dizziness, and nausea. Those using scalp cooling should make sure to take extra care of their hair, which means gentle brushing, alternating days of shampoo, avoiding hair color, skipping blow-drying, and avoiding hot tools like hair straighteners to help keep hair strong and prevent breakage.

There’s also been concern that scalp cooling can cause any stray cancer cells that may have spread into the scalp to not be adequately treated, allowing them to grow and metastasize in the scalp. Though reports of this have been rare, it’s best to discuss scalp cooling with your healthcare provider first so you can determine if it’s the best course of treatment for you.