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Can I Avoid Hair Loss During Chemo?

The facts about cold caps.

Photo credit: Courtesy of Jen Rozenbaum

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Dear Doctor:

My sister was just diagnosed with breast cancer. She begins chemotherapy in two weeks and is very concerned about hair loss—the thought of losing her hair, on top of everything else, is making her miserable. I was doing research online and discovered something called cold caps that claim to prevent hair loss during chemo. Is this a “thing"? Is it safe and does it work?


“Sister Sleuth”

Dear Sister Sleuth,

I’m sorry to hear about your sister’s diagnosis. Yes, cold caps are indeed a “thing.” They are scalp cooling systems that have been around for some time, and received FDA approval a few years ago. The science behind the cooling system is that when you apply something very cold to your scalp, it narrows the blood vessels in that area and reduces the amount of chemotherapy drugs that reach the hair follicles. So the hair that is covered by the cap is less likely to fall out.

About 15 percent of my patients try the cold cap. When done correctly, they are 50 to 60 percent effective, meaning people experience no or minimal hair loss. However, there are a few things people should know before they try it. First, cold caps are not covered by insurance, so there will be out-of-pocket costs. Second, cold caps are, well, very cold and uncomfortable. The patient must apply the cap 20 to 50 minutes prior to each treatment, wear it for the duration of each treatment, and keep it on for 20 to 50 minutes afterward. My patients report that the first 30 minutes are the worst (like an ice cream headache), and then it gets a little more tolerable. Last, the patient needs a friend or family member to get trained on how to properly apply the cap, and then stay with the patient for the duration of the treatment. All trainings are done by the company that supplies the cap. The process of getting it properly placed on the head is a very technical one—when applied correctly and evenly, they can work. But if every part of the scalp is not directly touching the cap, the patient will not receive maximum benefit and there may be patchy hair loss or thinning.

When these caps were first approved by the FDA, the main concern raised by the medical community and patients was that the scalp was not receiving the chemo drugs, so what if cancer cells are left behind? However, this has been studied extensively and the literature suggests that there have been no increase in cancers of the scalp as a result of cold cap usage.

So remember, your sister will need a constant helper and using a cold cap will make her treatments a bit more time consuming. But if she would like to give it a try, and that improves her spirits, I say why not? And hopefully, insurance companies will start covering the cost of cold caps soon so more patients will have opportunity to benefit from them.

“When done correctly, they are 50 to 60 percent effective, meaning people experience no or minimal hair loss.”
Dr. Veena John, oncologist
Dr. Veena John, oncologist | Photo credit: Donna Alberico for The Well

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Published July 10th, 2018

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