Widely used in Europe and Canada, "cold cap therapy," is a treatment that involves cooling the scalp during chemotherapy so that many potent anti-cancer drugs are prevented from getting to the hair follicles and damaging them. Chemotherapy is a major stressor on the body, and hair loss is one of its more visible effects. In scalp cooling, a cap filled with a cold gel or a refrigerated coolant in the form of a liquid is placed onto a patient's head during chemotherapy.

It's believed that cold cap therapy works in two ways, says Joycelyn Speight, MD, PhD, DABR, a San Francisco-based radiation oncologist and palliative care specialist with a particular interest in symptom management. "It constricts the capillaries or small blood vessels so that less of the drug reaches the hair follicle," she says. "The cold slows down the hair follicle 'metabolism,' making the hair cells in the follicle 'dormant' or less active, so the chemo has less of an effect."

"Women who are undergoing chemo come in, and their main concern, even with everything else going on, is hair loss," says Doris Day, MD, a dermatologist at Lenox Hill Hospital in New York City. "Hair loss has a powerful impact on self-esteem and is disruptive to a woman's life. If cold cap therapy is effective, I think it is worthwhile."

Cold cap therapy can be effective, says Neelima Denduluri, MD, a medical oncologist and hematologist with Virginia Cancer Specialists, a practice in The US Oncology Network. "The technology cools hair capillaries and prevents the absorption of chemotherapy agents into the hair bulbs of the scalp," she explains. Speight agrees. "It is absolutely worth explaining to a patient how the cooling cap works and having her consider it as an option. Whether or not to use it is an individual decision."

Scalp Cooling Not Effective for All Forms of Cancer

If the scalp is targeted for chemotherapy, one concern is that the cooling caps could interfere with the cancer treatment leading to an increase in metastases. The caps also don't appear to prevent hair loss in patients receiving chemotherapy for various forms of blood cancer, says Speight.

"How effective the cooling cap treatment is also depends on the particular drug being given, the dose intensity of the drug, and how well the cap is applied on the patient's head," Speight says. "It may not be as effective in patients who have received chemotherapy before, and if it doesn't work, it can leave a patient feeling more distressed than if they hadn't tried it at all."

Still, for cancer patients who are fighting not just the cancer itself, but for the chance to reclaim their former lives and looks, cooling caps can offer the opportunity to preserve their physical appearance. "The cooling caps really can minimize the destructive aspects of chemotherapy," Day says.

However, more clinical studies are needed before this treatment is recommended as standard care, Denduluri says. "We don't want to compromise the effectiveness of the chemotherapy, and the risks and benefits need to be weighed carefully," she says.

Neelima Denduluri, MD, reviewed this article.


Medical News Today. "Improved cooling caps for chemotherapy 'more effective.'" Web. 14 December 2013. http://www.medicalnewstoday.com/articles/270099.php

Associated Press. "Cold caps tested to prevent hair loss during chemo." 22 July 2013. http://www.nbcnews.com/health/cold-caps-tested-prevent-hair-loss-during-chemo-6C10704516