Scalp cooling
Scalp cooling is a way of reducing or preventing hair loss from chemotherapy. After treatment is over, it can also help hair grow back faster. It is often called a cold cap or cool cap.
How does scalp cooling work?
Scalp cooling reduces the temperature of the scalp. This makes the blood vessels in your scalp smaller and reduces the blood flow to your scalp. This can stop some chemotherapy drugs from affecting your hair follicles. Your chemotherapy nurse will be able to tell you if the cold cap may help reduce hair loss for you.
Types of scalp cooling
There are 2 types of scalp cooling:
- refrigerated cooling system
- cold gel cap.
Whichever type you use, your chemotherapy treatment will take longer than it would without scalp cooling. This is because you need to have the cold cap put on before you have the treatment. It also needs to stay on for some time after your treatment has finished.
Refrigerated cooling system
A machine pumps liquid coolant through the cap while you are wearing it. This reduces your scalp temperature. The cap generally feels lighter than a cold gel cap. While the cap is in place, you need to sit next to the machine. If you need a toilet break, your chemotherapy nurse can disconnect you from the machine.
Cold gel cap
This uses a special cap filled with frozen gel and kept in a freezer. The cold cap is fitted easily and kept in place with Velcro®. Your nurse will change the cap every 20 to 40 minutes to keep your scalp cool while you have your treatment.
Who can have scalp cooling?
Scalp cooling is only effective with certain chemotherapy drugs. Some hospitals are not able to offer it. Your doctor or chemotherapy nurse can tell you if it is available and suitable for you.
Scalp cooling can be used by people with any type of hair. To get the best results, it is important that you follow your chemotherapy nurse’s guidance on caring for and preparing your hair.
If you have Afro hair, you will need to remove any weaves or braids before trying scalp cooling. These put extra strain on the hair follicles. You will also need to avoid relaxing your hair chemically. Your chemotherapy nurse will have information and instructions about your particular hair type.
Scalp cooling is not suitable if any of the following apply to you:
- You have a blood (haematological) cancer, such as myeloma, leukaemia or lymphoma. This is because there is a risk of cancer cells surviving in the blood vessels of the scalp. This means the cancer may come back.
- You have a medical condition where you are very sensitive to cold.
- You are having continuous chemotherapy through a pump for several days.
- Your liver is not working as well as it should be. This means the chemotherapy drugs may stay in the body for longer than usual. It may not be possible to keep the scalp cold for long enough.
How well does the cold cap work?
How well the cold cap works varies from person to person. Scalp cooling works better with some chemotherapy drugs than others.
You will only know how well scalp cooling works for you by trying it. Even if you have scalp cooling, your hair is likely to get thinner. And some people who have scalp cooling will lose a lot of hair.
Even if you do lose your hair, you may want to continue with scalp cooling. Research has shown that for people who have scalp cooling, their hair grows back faster and stronger in the 12 weeks after treatment finishes.
The chemotherapy drug docetaxel can occasionally cause permanent hair loss. But having scalp cooling can help reduce the risk of this.
It is your choice whether to continue with scalp cooling. If you find it hard to cope with, or if it is not working well, you can stop it at any time. This includes during a treatment session.
Things to consider
Both types of cold cap need to be worn for 30 to 45 minutes before you have the chemotherapy, and for some time afterwards. How long the cap stays on for afterwards will depend on the chemotherapy drug you are having. You may wear the cap for a few hours in total.
Some people find the cold cap uncomfortable or heavy, especially for the first 15 to 30 minutes. You could try distracting yourself from the cold by talking to someone or listening to music.
It can also give some people a headache. Ask your chemotherapy nurse if you can have a mild painkiller to help.
The chemotherapy staff will help you feel as comfortable as possible. Things that might help include:
- hot drinks
- warm clothes
- blankets.
Scalp cooling only protects the hair on your scalp. Body hair may still fall out, including:
- eyelashes and eyebrows
- beards and moustaches
- chest hair
- pubic hair.
People used to think that scalp cooling may put you at risk of developing secondary cancers in the scalp. However, research has shown that scalp cooling does not increase the risk of developing secondary cancers in the scalp. If you are concerned about this, talk to your doctor.
Your chemotherapy nurse can tell you more about scalp cooling and what is involved. You can read about one person’s experience of scalp cooling from a member of our online community. Remember your experience may be different. The charity Cancer Hair Care also has more information and videos about scalp cooling.
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References
Below is a sample of the sources used in our cancer pain information. If you would like more information about the sources we use, please contact us at cancerinformationteam@macmillan.org.uk
Cancer Hair Care website: www.cancerhaircare.co.uk (accessed June 2022).
Dilawari A, Gallagher C, Alintah P, et al. Does scalp cooling have the same efficacy in Black patients receiving chemotherapy for breast cancer? Oncologist, 2021; Volume 26(4):292-e548. Available from www.doi:10.1002/onco.13690 (accessed June 2022).
Kinoshita T, Nakayama T, Fukuma E, et al. Efficacy of scalp cooling in preventing and recovering from chemotherapy-induced alopecia in breast cancer patients: The HOPE Study. Front Oncol, 2019; 9:733. Available from www.doi:10.3389/fonc.2019.00733 (accessed Oct 2022).
Sung-chan Gwark, Sei Hyun Ahn, Woo Chul Noh, et al. Similar negative emotional impact on hair loss in neoadjuvant endocrine therapy compared to neoadjuvant chemotherapy in young women with breast cancer from patient reported outcomes. Journal of Clinical Oncology, 2020; 38:15 suppl, e19242-e19242. Available from ascopubs.org/doi/abs/10.1200/JCO.2020.38.15_suppl.e19242 (accessed June 2022).
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