Managing Hair Loss with Scalp Cooling During Chemotherapy for Breast Cancer

This information explains how scalp cooling (using a cold cap) during chemotherapy may help reduce hair loss. It also gives some basic information about caring for your head and hair during chemotherapy.

Chemotherapy works by attacking fast-growing cells. Cancer cells are fast growing, but so are other cells such as hair cells. Chemotherapy can cause hair loss on your scalp, eyebrows, eye lashes, arms, legs, and pubic area. Depending on your chemotherapy, you can lose hair in none, some, or all of these areas.

You may start to see your hair fall out 1 to 4 weeks after your first chemotherapy treatment. How much of your hair falls out depends on the type of chemotherapy and how much and how often you receive it. Talk with your healthcare team about the amount of hair loss you should expect from the chemotherapy you will receive.

How quickly hair falls out also varies from person to person. The first signs of hair loss may be more hair on your pillow in the morning, in the shower, or when you brush your hair

Once your chemotherapy has stopped, your hair should begin to grow back. It can take 3 to 5 months for your hair to grow back, and it may have a different texture, color, or volume. For most people, hair grows in as fully as it was before chemotherapy.

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Reducing Hair Loss with Scalp Cooling

Scalp cooling is a way to reduce hair loss while you’re getting chemotherapy. It involves wearing a cold cap on your head before, during, and after receiving chemotherapy.

Scalp cooling has been used by people in Canada and parts of Europe for years. We now have results from clinical trials (research studies) in the United States. These studies show what we might expect from scalp cooling and how to best use this method to reduce hair loss during chemotherapy for breast cancer.

How effective is scalp cooling? Could I  still lose my hair?

The amount of hair you are left with after scalp cooling depends on how much hair you start with and how healthy your hair and scalp are before you start treatment. It also depends on the type and dose of the chemotherapy medication you are receiving.

Studies have shown that scalp cooling can work from 10% to 100% of the time. Therefore, it is hard to predict how effective scalp cooling will be for you. Most studies have found that people lose less hair and use head coverings or wigs less often when scalp cooling is used compared to when it is not used.

Even with scalp cooling, it’s normal to lose some hair (shedding) soon after you start treatment. This may not result in complete hair loss. The shedding may decrease as you continue to use scalp cooling during your chemotherapy treatment.

Even if you use one of the scalp cooling methods, there is no guarantee that you will not lose a significant amount of hair and need a hair covering. 

Is scalp cooling hard to tolerate?

Most people can tolerate scalp cooling. However, about 30 to 50% of the time people have side effects such as headaches, nausea, scalp pain, or feeling chilly. Some people also find the caps uncomfortably cold. A small number of people decide to stop using scalp cooling because of these side effects.

Are there any risks to doing scalp cooling?

There is a small risk of developing irritation on your scalp or forehead from cooling.

Some people worry about cancer cells traveling to the scalp and growing. There is a very small possibility of this happening and it is not affected by the use of scalp cooling.

How is scalp cooling done?

Scalp cooling is done by wearing a special cap on your head. There are 2 different ways to cool your scalp: using frozen cooling caps or by using a machine that continuously cools the cap.

Frozen cooling caps  

There are several well-known brands of cooling caps:

You can rent the Chemo Cold Cap and the Penguin cap through the companies that make them.  Your nurse can give you more information about these products.

It’s important for the caps to stay at the same cold temperature before, during, and after your treatment. To do this you will need to have multiple frozen caps available during each chemotherapy treatment and change them as they get warm. Follow each cap’s guidelines for how many caps you will need and how long you should wear each one.  

All caps have to be frozen ahead of time and brought to your chemotherapy appointment in a portable cooler with dry ice. You will need to plan ahead to bring a friend, family member, or a hired trained “capper” to help you change your cold cap during your treatment.

Cap attached to a cooling machine

The DigniCap® is a snug fitting cap that’s attached to a cooling machine that we have at Memorial Sloan Kettering (MSK). The machine circulates cold liquid through the cap while you’re wearing it.

The DigniCap is cleared by the Food and Drug Administration (FDA) for women with breast cancer. For more information about the Dignitana® scalp cooling system, go to dignicap.com/patients

How to use DigniCap

You must tell your doctor or nurse before your first treatment that you would like to use the DigniCap to cool your scalp. This allows us to schedule your time on the cooling machine. You may need to get your chemotherapy on a different day than the day that you see your doctor.

Before your first treatment, you will also have an appointment to be fitted for the right size DigniCap. You may need to try on several caps the first time to find the right fit. You will then wear the same size cap for each chemotherapy treatment.

Before putting on the cap at each treatment, you will need to wet your hair and comb it flat. The company suggests you cool recently washed hair, so you may want to shampoo your hair in the morning before your treatment.

How long does scalp cooling take during treatment?

Scalp cooling will add time before and after each of your chemotherapy treatments. How long you need to cool before and after your treatment depends on the type of cooling cap you’re using and your chemotherapy. It can range from 90 minutes to several hours. If you’re using frozen caps, you can return home with your cold cap on to finish your cooling.

Once you finish each chemotherapy treatment, you will complete your cooling in a separate area outside the chemotherapy infusion unit. This allows us to provide treatment to all patients during the day.  

Your healthcare team will answer your questions about how long cooling will take after treatments.

How much does a cold cap cost?

The cost of these products varies but can be as much as $750 per treatment. Most insurance companies don’t cover the cost of scalp cooling at this time.

Information for the cost of frozen cooling caps can be found by contacting the company or looking on their website(s). If you use DigniCap, MSK will bill you for the cost. If you have any questions about cost, call the Patient Financial Services department at 646-227-3378.

There’s some financial support available for scalp cooling from an organization called “Hair to Stay.” For more information, visit their website at www.hairtostay.org

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Caring for Your Hair and Head

Here are suggestions on how to care for your hair and head while you’re receiving treatment. For more information, search for our resource Hair Loss and Your Cancer Treatment on www.mskcc.org/pe or ask your nurse for it. 

  • Wash and condition your hair every 2 to 4 days with a fragrance-free shampoo and a cream rinse or hair conditioner.
  • Always rinse your hair well and pat it dry with a soft towel.
  • Cover your head with a hat, scarf, turban, or wig to keep it warm in winter and protected from sunburn year round. This can also help to contain falling hair.
  • Sleep on a satin or silk pillowcase. They’re smoother than other fabrics and can decrease hair tangles.
  • Brush or comb your hair gently with a soft-bristle brush or comb. Start brushing or combing your hair at the ends and gently work your way up to your scalp. You can also finger-comb your hair by moistening your fingers with water.
  • If your hair is long, you may want to have it cut short before you begin treatment.
  • Try using hair products specially designed to cover bald spots and thinning areas of your hair (such as Bumble and bumble™ Hair Powder).

Do not use the following things on your hair during treatment. They can be too harsh or pull on your hair.

  • Hair spray, creams or oils, hair dye, bleach, relaxers, or permanents (perm)
  • Clips, barrettes, bobby pins, pony tail holders, or scrunchies
  • Hair dryers, curlers, curling irons, hot rollers or a hair straightener
  • Rubber bathing or swimming caps

Also, don’t put your hair in braids, corn rows, or pony tails.

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Wigs and Head Coverings

You may still want to wear a wig or other hair covering during chemotherapy. Below is some basic information. If you have other questions or concerns, talk with your nurse.

Wigs

If you want to wear a wig, try to get one before your hair falls out because it will be easier to match your hair color and style. If you’ve already lost some or all of your hair, bring a photo of your usual hairstyle, and if you can, a lock of your hair to the wig store. This will help you find a wig that looks like your hair did before your treatment started.

When shopping for a wig, you may want to shop around and compare prices. A wig should fit properly, be comfortable, and be easy to care for. You may want to start wearing your wig as soon as your hair begins to thin. As your hair gets thinner, you may need to have your wig adjusted to make it fit better.

Many insurance companies will pay for wigs when hair loss is related to medical treatment. Contact your insurance company to find out what your plan offers. If you need help finding a place to purchase a wig, talk with your nurse.

Head coverings

Scarves, turbans, and hats can help hold hair that’s falling out and also hide a bald scalp. Head coverings come in a variety of colors, textures, and styles.

Scarves that are made from silk can easily slide off your head. You may want to buy a cotton blend scarf because it can be more comfortable and less likely to come untied or slip off your head.

Some women choose not to wear any head covering during their chemotherapy. This is an individual choice.

To learn more about what you can do to help you look and feel your best, you may want to attend the Look Good Feel Better program. To register or find a workshop near you, call 1-800-395-LOOK (1-800-395-5665) or visit their website at www.lookgoodfeelbetter.org

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