Hair loss has long been a distressing​ ​and well-recognized side e​ffect of chemotherapy. Now, fitted cooling caps worn before, during and after chemotherapy sessions are helping some patients keep their hair and skip the wigs and head coverings they might otherwise have used.

“This is such an important aspect of patient well-being and healing,” says Nancy Marshall, co-founder of the Rapunzel Project, a nonprofit that educates patients about cooling cap options.

​Caps that could be manually frozen, either with dry ice or in biomedical freezers, like the Arctic Cold Cap and Penguin Cold Cap, were among the first products​ used to keep the head cool to prevent hair loss during chemotherapy.

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Photo via DigniCap

Now, there are two cooling machines that the U.S. Food and Drug Administration (FDA) has ​cleared for distribution to patients with any type of solid tumor: the DigniCap Scalp Cooling System and the Paxman Cooling Cap. Because these caps have been cleared by the FDA, insurers are more likely to cover them. Marshall says FDA clearance also increases the likelihood that doctors will recommend them.

Cooling caps are thought to work by constricting the blood vessels in the scalp. This reduces the amount of chemotherapy drugs that gets to the hair follicles and the hair cells. Clinical trials for the Paxman and DigniCap systems found that 50 to 66 percent of breast cancer patients in the group that used a cooling cap kept most of their hair, while 100 percent of patients who did not use a cap lost all or most of their hair.

​All of the caps work better with some types of chemotherapy than others, says Julie Nangia, an oncologist at the Baylor College of Medicine in Houston. Patients on taxane drugs, like Taxol (paclitaxel) and Taxotere (docetaxel), for example, generally keep more hair ​than patients being treated with an anthracycline, such as Adriamycin (doxorubicin) or Ellence (epirubicin).

Cooling may also help with other treatment-related side effects. A Japanese research team reported in the February 2018 Journal of the National Cancer Institute​ that fitting patients with frozen socks and mittens during treatments prevented chemotherapy-induced neuropathy—pain, tingling or numbness in the hands and feet.

The Cost of Cooling​

Organizations offer assistance in affording cooling caps.

Cooling caps vary in price, and some require security deposits or have shipping costs. These are four of the available options. Check with your insurer to see what they may cover.

  • Arctic Cold Cap: $379 per month and up.
  • Penguin Cold Cap: $495 per month.
  • DigniCap: $275 to $350 per treatment.
  • Paxman Cap Kit: $800 for the first four treatments, plus $500 for the cap.

HairToStay gives subsidies to eligible patients to help offset the cost of scalp cooling.

Cold Capital Fund provides assistance to cancer patients in Maryland, Virginia and Washington, D.C.

The Rapu​nzel Project offers information about preventing hair loss and a list of which cancer centers have which caps and how to locate them.​

​Dawn Hershman, an oncologist at the Herbert Irving Comprehensive Cancer Center at Columbia University in New York City, who wrote an editorial published along with the study, says she was “surprised” that cooling helped reduce neuropathy. “I don’t know that anybody understands what the mechanism for that would be,” she says.

​Hershman says that although more research is needed, she finds the results encouraging. “This doesn’t have a lot of side effects, is not horribly expensive and is only administered during, before and after the infusion,” she says. “It could be very helpful.”