An Overview of Scalp Cooling

Scalp cooling (also referred to as scalp hypothermia) helps reduce the amount of hair loss caused by certain chemotherapy drugs. Using ice packs or a cooling cap before, during, and after a chemotherapy treatment can either prevent or drastically reduce hair loss.

Chemotherapy drugs help to destroy cancer cells in the body—both at the tumor site as well as throughout the whole body since cancer cells can multiply and divide very quickly. Because chemotherapy is targeting all dividing cells, it can’t tell which ones are cancerous and which are healthy.

Since hair cells also divide quickly, this means they can become a casualty of chemotherapy as well, destroying the hair cells and causing hair loss in someone undergoing chemotherapy. 

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 Fahrenheit. A cooling cap will narrow the blood vessels under the scalp which helps prevent the amount 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, meaning roughly every 30 minutes the cap will need to be replaced.

The second way to approach scalp cooling is by using a scalp cooling system, which is a relatively new technology available only starting in 2016. There are currently two scalp cooling systems approved by the United States Food and Drug Administration: the DigniCap Scalp Cooling System and the Paxman Scalp Cooling System.

These systems work the same way as a cooling cap does, but with a scalp cooling system, the cooling cap is attached to a refrigeration unit which delivers the coolant to the scalp continuously—there’s no need to change the cap once it’s on.

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

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 (FSA) or health savings account (HSA) to help pay for scalp cooling treatment. Cooling cap prices depend on the manufacturer and can be found by visiting the website. (Just keep in mind you’ll need more than one cap to swap out during treatments.)

If you use a scalp cooling treatment, the price will depend on how many treatments you need and 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.

Research published in the March 2018 edition of the Journal of Oncology found that depending on the type of chemotherapy drugs used, scalp cooling could be extremely beneficial. Women using a Paxman cooling system who had different types of chemotherapy, from taxane-based to an anthracycline, kept anywhere from 16 to 59 percent of their hair.

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

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, and skipping blow drying or hair straightening 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 go undetected, 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 doctor first so you can determine if it’s the best course of treatment for you.