Cooling Caps Show Promise in Reducing Hair Loss from Chemotherapy

nurse places the DigniCap cool cap on woman's head

Two studies by researchers from cancer centers across the US found that scalp cooling devices can often help reduce hair loss during chemotherapy. The studies looked at women undergoing chemotherapy for breast cancer. In both studies, scalp cooling was linked to the prevention of significant hair loss in about half the women using the devices. Both studies were published February 14 in the Journal of the American Medical Association.

Hair loss is a common side effect of certain types of chemotherapy – including the types often used to treat breast cancer. Although hair typically grows back after treatment ends, it can take a long time. Reducing this side effect is considered important to overall treatment by improving quality of life for many women. According to both studies, women rate hair loss as one of the most distressing side effects of chemo.

Scalp cooling devices, also called cooling caps or cold caps, are worn on the head during chemotherapy treatments to try to prevent or lessen hair loss. They are thought to work by tightening up blood vessels in the scalp, which reduces the amount of chemo that reaches cells in the hair follicles. They are also thought to decrease activity in the hair follicles, making them less likely to be affected by the chemo. Newer versions of these devices use a computer to circulate a cooled liquid through a cap that is worn during treatment. A second cap made from neoprene covers the cooling cap in order to hold it in place and keep the cold from escaping.

In one study, 182 women getting chemotherapy for breast cancer were randomly assigned to either a scalp cooling device or no scalp cooling. Those who wore the cooling cap were significantly more likely to have less than 50% hair loss after their 4th chemo cycle than those who had no scalp cooling. Some women reported minor side effects including headache, scalp pain, and skin problems.

In the other study, 106 women in a scalp cooling group were compared with 16 in a control group who did not use the device. Results were similar, in that women who wore the cooling cap had significantly less hair loss after 4 rounds of chemo. Side effects were similar, too.

Results varied depending on the specific type of drug the women received. Len Lichtenfeld, MD, deputy chief medical officer of the American Cancer Society, cautions women to fully understand the potential benefits and limitations of the devices before making the decision about whether to use them. He says any decision should be made after realistic and honest discussions with a woman’s health care team.

Cold caps

The study of 106 women used the DigniCap, the first scalp cooling device to be cleared for marketing by the US Food and Drug Administration (FDA). The other study used the Paxman scalp cooling system, which is currently being evaluated by the FDA. At this time, scalp cooling in the US with the newer systems costs about $1500 to $3000 total per person and so far is not likely to be reimbursed by health insurance, according to an editorial accompanying the studies. Other versions of cap cooling devices can be rented or purchased online, and some cancer treatment facilities in the US allow patients to use them.

Although cold caps have been around for many years, some doctors have been concerned they could interfere with chemo by keeping it from reaching any stray cancer cells lurking in the scalp. Some believe that the scalp cooling might protect any cancer cells there and allow them to survive the chemo and keep growing.

However, recent studies have shown no link between scalp cooling and cancer cells spreading to the scalp, or decreased survival among women with breast cancer. None of the women in the JAMA studies developed cancer spread to the scalp during the 2-to-3-year study periods; researchers will continue to monitor them for up to 5 years.

The American Cancer Society medical and editorial content team

Our team is made up of doctors and oncology certified nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.

Effect of a Scalp Cooling Device on Alopecia in Women Undergoing Chemotherapy for Breast Cancer The SCALP Randomized Clinical Trial. Published February 14, 2017 in the Journal of the American Medical Association. First author Julie Nangia, MD, Baylor College of Medicine, Houston.

Association Between Use of a Scalp Cooling Device and Alopecia After Chemotherapy for Breast Cancer. Published February 14, 2017 in the Journal of the American Medical Association. First author Hope S. Rugo, MD, Helen University of California, San Francisco.

Cold Caps (Scalp Hypothermia)

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