Cold Caps During Chemo: Pros & Cons

Research indicates 47% of female patients in the U.S. consider hair loss the most traumatic aspect of chemotherapy. Many women are willing to try something to help prevent chemo-induced hair loss, even if there is no guarantee. Although the use of scalp cooling for the prevention of chemotherapy-induced hair loss is more common in Europe, chemo cold caps are becoming more prevalent in the U.S. Cool caps are placed on the hair-bearing areas of the scalp for 20 to 50 minutes before, during, and after chemo. Scalp hypothermia (cold caps or scalp cooling) must be started right before the first chemo session commences.

It is theorized the cooling action may help prevent extensive hair loss in people undergoing chemotherapy. Cold caps and scalp cooling systems work by narrowing the blood vessels beneath the skin of the scalp, thereby reducing the amount of chemotherapy medicine reaching hair follicles. The cold also decreases the activity of hair follicles, slowing down cell division and reducing the impact of chemotherapy on the follicles.


Cold Caps Versus Scalp Cooling Systems

Both cold caps and scalp cooling systems utilize tightly fitting, lightweight helmet-type hats filled with a gel coolant chilled to -15 to -40 degrees Fahrenheit. Similar to ice packs, cold caps are kept in a special freezer before the patient wears it. Because cold caps thaw out during a chemotherapy infusion session, they need to be replaced about every 30 minutes. Women usually rent the caps, a special freezer, or a container with dry ice and a laser thermometer to ensure the correct temperature is maintained. Penguin, Chemo Cold Caps, Dignicap, Paxman and ElastoGel are a few of the more well-known cold cap brands. There are no side-by-side chemo cold caps reviews, however, many women have blogged about their individual experiences with specific brands.

With scalp cooling systems, the cap is attached to a small refrigeration machine that circulates coolant. The cap only has to be fitted once and doesn’t need to be replaced during chemo. Cancer treatment centers purchase scalp cooling systems and patients are charged for their use.

The cost of cool caps varies depending on the manufacturer, the number of chemotherapy sessions, and the duration of treatment. Some insurance carriers may cover the cost of renting caps or using a scalp cooling system.


Treatment Tips

The extremely cold cap can make you chilled, so it is a good idea to dress warmly and bring warm blankets and/or electric heating pads to chemo. In addition, the following hair care tips should be followed during treatment.

  • Do not blow dry hair, use hot rollers, or straightening irons

  • Shampoo every third day with cool water and a gentle shampoo

  • Use paraben- and sulfate-free shampoo

  • Gently comb hair but do not brush it

  • Do not color hair until three months post-chemotherapy

  • Do not cut hair

  • Avoid getting scalp hot, so no hats, scarves, or wigs

  • Do not expose hair to saltwater or chlorine

  • Do not tie hair back



Adverse Side Effects

Headaches, neck and shoulder discomfort, chills, and pain are common complaints. Others have said wearing a cold cap feels like the brain freeze one gets from eating ice cream too quickly or complained of a burning sensation followed by numbness. Some physicians are concerned the caps may prevent chemotherapy medicine from reaching stray cancer cells in the scalp. 


Improper application procedures, although infrequent, can result in adverse side effects such as cold thermal injuries. At present, there are no evidence-based scalp cooling protocols and no regulatory oversight of their use. In a small study on four patients, cold thermal injuries were moderate and improved with topical interventions and interruption of cool cap use. Despite their use, three patients still experienced persistent hair alopecia (hair loss). Although these injuries are usually mild to moderate in severity, the potential occurrence of permanent alopecia and scarring or the need to discontinue cool cap use are unknown. Prospective studies are needed to further elucidate the risk, standardize delivery methods, and improve patient, provider, and caregiver education about their use.



Scientific Studies

The U.S. Food and Drug Administration approved the DigniCap® system manufactured in Sweden, based on a clinical trial on 122 women with stage I or stage II breast cancer who were getting chemotherapy. More than two-thirds of the women who used DigniCap reported losing less than 50% of their hair. The two-piece cooling cap system is controlled by a computer, which helps circulate a cooled liquid through the cap worn during chemo. A second cap made from neoprene covers the cooling cap to hold it in place and keep the cold from escaping.

Many of the best outcomes from scalp cooling are associated with studies conducted in the Netherlands. More successful outcomes were associated with well-fitting caps in which there was a close contact between the cap and scalp. While some studies showed benefits, many patients using scalp hypothermia still experienced some hair loss. One study suggested people with a thicker hair were more likely to lose hair than those with thinner hair. This appeared to be because the scalp didn’t cool down adequately due to the insulating effect of the hair.

It is believed the efficacy of scalp hypothermia may be related to the types of chemo used, the chemo dosage, how well the cap fits, a person’s hair texture, and how well he or she tolerates the cold temperature.


Cool Caps Are Not for Everyone

A cool cap is not appropriate for patients with advanced-stage cancers that have metastasized. There is a remote chance stray cancer cells have escaped to the scalp and if the area is cooled, the scalp could harbor these cells. Moreover, it is thought once chemo is complete, cancer cells could move and grow elsewhere. Likewise, cold caps are not suitable for blood cancers such as leukemia because cancer is circulating throughout the body. People undergoing continuous chemotherapy over several days cannot use cold caps because it is impractical to keep the scalp cold for such a long duration.

Click HERE for more information on chemo related hair loss.

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