Cold caps and scalp cooling systems are tightly fitting, strap-on, helmet-type hats filled with a gel coolant that’s chilled to between -15 and -40 degrees Fahrenheit. These caps and scalp cooling systems may help some women keep some or quite a bit of their hair during chemotherapy.
A retrospective study that looked at the results of three studies on scalp cooling in people being treated with chemotherapy found that scalp cooling was more effective in people being treated with taxane chemotherapy compared to anthracycline-based chemotherapy. The study also found that the risk of scalp skin metastases was extremely low and should not interfere with the use of scalp cooling.
The research was published in the March 2018 issue of the Journal of Oncology Practice. Read the abstract of “Management of Chemotherapy-Induced Alopecia With Scalp Cooling.”
Cold caps have been used in Europe since the 1970s. The U.S. Food and Drug Administration has given clearance to two scalp cooling systems: the DigniCap Scalp Cooling System and the Paxman Scalp Cooling System.
Scalp cooling works by narrowing the blood vessels beneath the skin of the scalp, reducing the amount of chemotherapy medicine that reaches the hair follicles. With less chemotherapy medicine in the follicles, the hair may be less likely to fall out. The cold also decreases the activity of the hair follicles, which slows down cell division and makes them less affected by the chemotherapy medicine.
Cold caps and scalp cooling systems are slightly different. Cold caps are similar to ice packs. Kept in a freezer before they’re worn, cold caps thaw out during a chemotherapy infusion session and need to be replaced with a new cap about every 30 minutes. Women usually rent the caps. Penguin, Chemo, and ElastoGel are some brand names.
With scalp cooling systems, the cap is attached to a small refrigeration machine that circulates coolant, so the cap only has to be fitted once. The scalp cooling systems are purchased by a cancer treatment center and people are charged to use the system while receiving chemotherapy.
With both types of cooling, you wear the cap for 20 to 50 minutes before receiving chemotherapy, while you’re receiving chemotherapy, and for a certain amount of time after the chemotherapy infusion is completed.
The three studies analyzed included 407 women who had been diagnosed with breast cancer. Two of the studies looked at women diagnosed with early-stage disease and the third looked at women with both early-stage and metastatic disease:
- In the SCALP trial, which used the Paxman system, women treated with taxane-based chemotherapy kept 59% of their hair. Women treated with a taxane followed by an anthracycline kept 16% of their hair. Women treated with weekly Taxol (chemical name: paclitaxel), a taxane, kept 100% of their hair.
- In the second study, which used the DigniCap system, women treated with taxane-based chemotherapy kept 66% of their hair. Women treated with weekly Taxol kept 100% of their hair. This study did not include women treated with a taxane followed by an anthracycline.
- In the third study, which used Penguin Cold Caps and included women diagnosed with metastatic disease, women treated with taxane-based chemotherapy kept 50% to 84% of their hair. Women treated with anthracycline-based chemotherapy kept 20% to 43% of their hair.
The researchers said that while follow-up time in the studies was short, the “data suggest that the incidence of scalp metastases related to scalp cooling is low.”
Common side effects of cold caps and scalp cooling systems are headaches and feeling cold while wearing them.
The most common side effects reported in the studies were:
The cost of scalp cooling ranges from about $1,500 to $3,000. Some insurance plans will cover the cost of scalp cooling. Others do not. HairToStay is a nonprofit organization that helps people afford the cost of scalp cooling. In addition, the Rapunzel Project is a nonprofit organization dedicated to helping women and men undergoing chemotherapy access and use scalp-cooling technology to help keep their hair.
If you’re interested in trying scalp cooling, talk to your doctor about all the factors that need to be taken into account, including your chemotherapy regimen and any other health issues you may have. Women with a history of migraines should not use scalp cooling systems.
Women who use scalp cooling during chemotherapy are advised to baby their hair during treatment:
- no blow drying, hot rollers, or straightening irons
- shampoo only every third day with cool water and a gentle shampoo
- no coloring until 3 months after chemotherapy is done
- gentle combing and brushing
See what our Community members are saying about scalp cooling in the Breastcancer.org Discussion Board thread Cold Cap Users Past and Present, to Save Hair.
Breastcancer.org has done podcasts with the researchers who did the studies on the DigniCap system and the Paxman system:
- Listen to the podcast with Dr. Hope Rugo about her research on the DigniCap Scalp Cooling System.
- Listen to the podcast with Dr. Julie Nangia about her research on the Paxman Scalp Cooling System.
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