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Many people diagnosed with breast cancer worry about experiencing hair loss, a common side effect of chemotherapy (chemo) and other cancer treatments. Those who undergo such therapies may worry about how they’ll look, what others will think, and whether their hair will grow back after treatment has ended.
Some people with breast cancer use cold caps to help limit hair loss during chemotherapy. These caps deliver cooling to the head and have proved effective in helping to lessen hair loss.
Here, we will examine how cold caps may be used to help minimize hair loss during chemotherapy for breast cancer, including how they work and how to cover the cost of these caps during treatment. As always, it’s best to consult your oncologist or health care team before trying any new hair loss therapies during cancer treatment.
Chemotherapy targets cells that multiply and grow rapidly. Cancer cells fall into this category, but so do hair cells. Because of this, chemotherapy drugs kill cancerous cells as well as hair cells, leading to hair loss.
Other types of breast cancer treatment cause hair loss for similar reasons. Although hair loss most commonly happens during chemotherapy, it can also happen with radiation therapy, hormonal therapy, immunotherapy, and targeted therapy.
Some cancer treatments cause hair thinning, which you may not even notice. Others may cause hair to fall out quickly in large clumps. Note that although hair loss on the scalp is a common side effect of treatment, body hair loss (such as eyelashes, eyebrows, and pubic hair) can also occur.
Also known as cooling caps, cold caps are exactly what the name implies: caps that fit tightly over the skull and function to make the head cold.
There are two types of cold caps. The first type, manual cooling systems — sometimes referred to as the “old” cold caps — are like fitted ice packs. They need to be stored in a freezer between uses. You’ll need multiple caps, as you’ll want to wear them before, during, and after chemotherapy and replace them every 20 to 30 minutes during this process.
People with breast cancer usually rent these caps, then pack them in dry ice to bring to their chemo treatments. Storing them and replacing them usually requires having a family member or another person present at the treatment session. You could also coordinate with the chemo center ahead of time.
The second type includes automated cooling systems, also referred to as the “new cold caps.” These fitted caps attach to a refrigeration unit by a hose. The hose pumps refrigerated liquid through the cap when the machine is turned on, delivering automated cooling to the head.
Many cancer care centers offer these types of caps for use during chemotherapy sessions. Some people choose to rent one or buy one so that they know they have their own cap available whenever they need it.
In a 2021 review published in the journal Supportive Care in Cancer, researchers reported that scalp cooling therapies to prevent hair loss during breast cancer treatment cause a number of common side effects, including:
MyBCTeam members report differing experiences using cold caps. “It’s only painful for a minute or two until the follicles freeze,” wrote one member. “Once they’re frozen, there’s no discomfort anymore during treatment.”
Another member described the cold cap as the worst part of their first chemo treatment: “The treatment wasn’t bad, but the nine hours of cold caps worn on my head was brutal!!”
For manual cold caps, be prepared for a certain amount of effort. One MyBCTeam member described their experience: “Every week, my husband and I take two large coolers filled with dry ice and several caps to the city for treatments. The caps are to be worn before, during, and after treatment. I use 14 caps during each treatment, changing one out for another every half hour.”
Another member, however, found comfort in having cold cap changes to keep busy during chemo. “It gave my husband and I something to focus on and made treatments go by quickly,” they explained.
Members also share the detailed ultra-gentle hair care regimens they must stick with along with using cold caps to preserve their hair.
Most people wear cold caps for at least 30 minutes before chemotherapy starts, throughout the chemo session, and for anywhere from 20 minutes to five hours afterward, depending on the type of chemotherapy they’re receiving.
Some MyBCTeam members share that they decided against using cold caps specifically because of the extra hours they would need to spend at the infusion facility. Others wrestle with continuing cold caps after the first treatment, finding it difficult to weigh the potential benefits. “I don’t want to go through the four hours of brain freeze if I’m buzzing off my hair by next week,” shared one member.
In theory, cold caps work in a couple of ways. First, they slow down activity in the hair cells, making them less likely to be targeted by chemotherapy medications. This means that the medications may pass the hair cells by, rather than attacking them in the same way they attack fast-growing cancer cells.
Cold also acts to narrow the blood vessels around hair cells, slowing blood flow to the area. Even if chemotherapy drugs are still attracted to the hair cells, slowed blood flow means that less medication than usual will reach the hair follicles. This can help save some hair cells, meaning less hair loss during chemotherapy treatments.
According to the authors of the 2021 review, scalp cooling can significantly improve hair loss due to chemo. Researchers found a huge range of effectiveness, from 27 percent to 90 percent, with a total overall effectiveness rate of 61 percent.
The researchers suggested that the effectiveness of scalp cooling may vary among chemotherapy regimens, depending on which drugs are used. Your doctor can help you determine whether cold caps may be more or less effective given your specific regimen.
MyBCTeam members who used cold caps mostly report being satisfied with their decision:
Whether to use cold caps is a highly personal decision that depends on how you weigh the benefits of reducing hair loss versus the cost, time, effort, and potential discomfort. As one member put it, “Besides the hair care after, the added time on treatment days, and the expense, it’s totally worth it. Having hair allowed me to look and feel a little more normal. Everyone is different, but it worked well for me.”
It’s also important to note that cold caps minimize the loss of hair only on the head. Hair on the face and body will still fall out. “Yes, I lost my lashes eventually and eyebrows,” one member said in answer to another’s question. “Cold cap does not protect that hair.”
The U.S. Food and Drug Administration (FDA) has approved three models of automated cold caps for hair loss prevention during cancer treatment:
There are also several brands of the old type, though these are not FDA-approved. These include:
Some people try to mimic the effects of a cold cap with ice packs held or bound to the head. While these may serve the same purpose, getting them in place and keeping them there during a chemotherapy session can be difficult. Most people find it worthwhile to instead use caps designed for this purpose.
Cold caps can be expensive. Depending on the type of cap and how long you will need it, costs can run from $380 to $450 per month. In addition, some cancer centers will charge you for the cap every time you use it.
Many insurance companies don’t cover the cost of cold cap use, regardless of type. However, it’s worthwhile to ask your insurance company if they will cover a cap and to have your health care team or an oncology specialist support your request in writing. This may help you get the insurance coverage you need.
Both DigniCap and Paxman report that some of the people who use their caps have been able to get reimbursement from their insurance companies. This means that you pay for the cap, then submit your bills to your insurance company, along with a request that they pay. If they decide it is legitimate, they will reimburse you all or part of what you spend on the caps.
If insurance is not a good option for you, talk with your cancer treatment center about how to get your costs covered. They may be able to offer options that you would not have known about otherwise.
Finally, organizations like The Rapunzel Project and HairToStay might be able to help you out. These nonprofits are dedicated to helping people diagnosed with cancer keep their hair or get access to other quality options.
MyBCTeam is the online social network for people diagnosed with breast cancer and those who love and care for them. Here, you can also share your story, participate in ongoing conversations, and get to know other people from around the world who will understand your journey with breast cancer.
Did you use a cold cap to limit hair loss during chemo? Would you recommend it to others? Share your experience in the comments below or by posting on your Activities page.
Richard LoCicero, M.D. has a private practice specializing in hematology and medical oncology at the Longstreet Clinic Cancer Center, in Gainesville, Georgia. Review provided by VeriMed Healthcare Network. Learn more about him here.
Kelly Crumrin is a senior editor at MyHealthTeam and leads the creation of content that educates and empowers people with chronic illnesses. Learn more about her here.
Sarah Winfrey is a writer at MyHealthTeam. Learn more about her here.
