Chemotherapy can cause a variety of side effects, from fatigue and nausea to neuropathy and brain fog. But for some people, one of the most difficult side effects to deal with is hair loss.
“When you’re diagnosed with cancer, you already feel such a loss of control. Losing your hair just compounds that,” says Taylor Novice, M.D., a dermatology resident at Henry Ford Health. “I’ve had patients say they wouldn’t go through chemotherapy again if they had to lose their hair. If you can save your hair—if you can look in the mirror and still recognize yourself—it means a lot.
“Caring about hair loss is stigmatized in our society, as though you should just be happy to be alive. And of course, there’s a huge gratitude for being able to receive cancer treatment, but it doesn’t negate the fact that hair loss is a huge physical change for many patients.”
What Is Scalp Cooling Therapy?
Chemotherapy is a systemic treatment, meaning it circulates in the blood to attack rapidly dividing cells with the goal of destroying cancer cells. In the process, healthy cells (such as hair follicles) end up being damaged, too. Many types of chemotherapies cause varying degrees of hair loss.
But a treatment called scalp cooling therapy may help. “It’s basically a cold cap that you wear during chemotherapy,” says Dr. Novice. “The cold temperature narrows the blood vessels in your scalp, limiting the amount of chemotherapy that’s able to reach your hair follicles.”
In order for it to work, you must start wearing the cap before your first chemotherapy infusion. You must cap every chemotherapy day—before, during and after you receive the chemotherapy infusion.
“Generally, the first three weeks after chemotherapy is when you start to see hair loss,” says Dr. Novice. “If you don’t wear the cap for that first infusion, you’ve likely already damaged the hair follicles and the cap won’t work.”
Machine Vs. Manual Scalp Cooling Therapy
There are two types of scalp cooling therapy: machine and manual. With machine scalp cooling therapy, the cap is hooked up to a machine (provided by the hospital) that circulates cold air. You typically start wearing it 30 minutes before each chemotherapy infusion and for 90 minutes post chemotherapy. For chemotherapies that are harsher on the hair, you can start wearing it 45 minutes before.
Manual scalp cooling therapy is a more tedious process. You rent a few caps (unaffiliated with the hospital) that come in a cooler. You must purchase dry ice for the cooler and bring everything with you to each chemotherapy infusion. To maintain a cold temperature on your scalp, your “capper” (typically a family member or friend) must change the cap every 25 minutes. It’s advised to start wearing the cap hours before each chemotherapy infusion and continue wearing it for a few hours after the infusion. The exact length of time depends upon the type of chemotherapy you receive.
To maximize results, treat your hair very gently for the duration of chemotherapy—and for about three to six months after completing chemotherapy. For example:
- Wash your hair no more than three times per week using a gentle, sulfate-free shampoo. If possible, use a tub of water or faucet to wash your hair instead of a highly pressurized showerhead.
- Do not use any heat tools on your hair.
- Do not color your hair.
- To minimize tension on the hair, try to not wear your hair up in a tight ponytail or bun.
- Use a gentle hairbrush, like a wide-tooth comb.
“These recommendations aren’t all entirely evidence based, but the thought is they lessen the amount of trauma to your hair since it is already fragile,” says Dr. Novice.
Results Of Scalp Cooling Therapy
Your success with scalp cooling therapy depends upon several factors, including the type of chemotherapy you receive and how snug the cap fits on your head. “Typically, we define success as keeping enough hair that people wouldn’t know you’re going through chemotherapy—which means keeping at least 50% of your hair,” says Dr. Novice.
And even if you do lose your hair? Studies show that scalp cooling therapy makes your hair grow back faster after chemotherapy. But there are barriers to receive scalp cooling therapy, from patients not knowing about it to the price.
“It costs approximately $1,500 - $3,000 for the entire treatment and is inconsistently and infrequently covered by insurance,” says Dr. Novice. “However, we still recommend reaching out to your insurance provider since the landscape is changing as we speak. And nonprofit groups, such as HairToStay and Cap & Conquer provide need-based funding. Getting a cancer diagnosis is so overwhelming. It’s easy to push hair to the side and say, ‘I have bigger fish to fry.’ But it’s important for people to know they have options.”
Ask your oncologist or a member of your cancer care team to see if scalp cooling is right for you. To learn more about scalp cooling therapy, call 313-556-8179.
To make an appointment with a cancer specialist, visit henryford.com/cancer or call 888-777-4167.
Taylor Novice, M.D., M.B.A., is a dermatology resident at Henry Ford Health, where she performs scalp cooling research and advocates for scalp cooling integration. She also runs a non-profit called Cap & Conquer to raise money for cancer patients who could not otherwise afford scalp cooling therapy.