DEAR MAYO CLINIC: How effective is cold cap therapy in preventing hair loss in people undergoing chemotherapy treatments? Are there any risks?
ANSWER: Using a cold cap can significantly reduce hair loss caused by chemotherapy. Although some minor side effects may occur, no serious side effects have been associated with cold caps. Some have questioned whether cold caps might prevent chemotherapy from reaching cancer cells in the scalp. But that risk appears to be low.
Chemotherapy works by killing rapidly dividing cells, including cancer cells. But chemotherapy can’t tell the difference between cancer cells and other normal cells that also divide quickly, such as those in hair follicles. When chemotherapy attacks the hair follicles, it causes the hair to fall out.
In some cases, chemotherapy may only lead to thinning hair. In others, it makes all of a person’s hair fall out. For example, studies have shown that most of the chemotherapy drugs used to treat breast cancer cause almost total hair loss in most patients.
While losing your hair may sound like a small price to pay for preventing cancer from coming back, it’s a side effect that’s often hard to take. Not only can losing your hair be tough on your self-image, it’s also a vivid and constant reminder of a cancer diagnosis.
The idea of cooling the scalp to prevent hair loss has been around for some time. When cooled, the blood vessels in the scalp constrict, reducing blood flow to the hair follicles. That means less chemotherapy medication can get into the hair follicle cells. The cold also makes those cells less active, so chemotherapy drugs don’t target them as quickly.
In the past, the scalp was cooled during chemotherapy with cold packs alone or with caps that were kept in dry ice that had to be changed frequently to keep the temperature low. In 2015, however, the U.S. Food and Drug Administration approved a new type of cold cap to reduce hair loss in people undergoing chemotherapy.
The new caps have cold liquid circulating through them and are connected to a computer that maintains the temperature of the cap at around 32 degrees Fahrenheit. These caps also have a covering that keeps them in place and helps to keep the temperature constant.
One recent study examined the effects of the newer cold caps in women undergoing chemotherapy treatment for early-stage breast cancer. Of those who wore a cap consistently cooled to 32 degrees for 30 minutes before their chemotherapy treatment, throughout every chemo session, and for 90 to 120 minutes afterward, 66 percent experienced hair loss of 50 percent or less. That was compared to another group undergoing chemotherapy that did not use the caps. All of those patients lost more than half of their hair.
Several minor side effects were noted in this study, including chills, headaches, scalp irritation, and neck and shoulder discomfort. Of the more than 100 women in the group who wore cold caps, only three stopped using the cap during the study because it made them feel too cold.
Some health care providers have been concerned that cold cap therapy could prevent chemotherapy from reaching cancer cells that may be in the scalp, making the chemotherapy less effective. In people who have used cold caps, reports of cancer appearing in the scalp are extremely rare. More research is needed, however, to clearly understand this potential risk.
Another consideration regarding cold caps is the cost. At this time, some medical insurance companies don’t cover the cost of cold cap therapy. If you are considering using a cold cap while undergoing chemotherapy, check with your insurance provider to see if your policy covers it or if you would have to pay for it yourself. Typically, cold cap therapy costs around $400 per session. — Dr. Saranya Chumsri, Medical Oncology, Mayo Clinic, Jacksonville, Florida