Patient Education

Patients who plan to use scalp cooling during their chemotherapy sessions should receive additional information and instructions specific to its use. The following are points to discuss with patients considering scalp hypothermia:

• The technique is not perfect. You will experience some hair loss.

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• Scalp cooling is not comfortable, but it is tolerable. The caps must be very cold to be effective. A manual cap is at treatment temperature when you put it on; cooling systems chill the cap after you put it on. Your scalp will become numb from the cold.

• You need to bring someone with you to each chemotherapy session to help you with putting on the cooling cap initially, and with changing the manual caps as they become too warm.

• You will feel chilly. You should dress in warm clothes and bring a blanket.

• Baby your hair. Do not shampoo for 3 days before and 3 days after each chemotherapy session. In addition, avoid using hot rollers, curling irons, and products that use alcohol or peroxide; and do not color, tug at, or blow dry your hair for at least 3 months after completing your last course of chemotherapy.

• Scalp cooling will lengthen your time at the infusion center to most of the day. The cold cap is worn at treatment temperature for approximately 1 hour prior to beginning each chemotherapy session, and you will keep it on for as long as 4 hours after completing your infusion, depending on the cooling method.

• Your health insurance plan may not cover scalp cooling. Patients who cannot afford scalp cooling may qualify for a subsidy from organizations that advocate use of the technique.

Advocates for Cold Caps

The Rapunzel Project Founded by 2 breast cancer survivors, the Rapunzel Project spreads the word about scalp cooling. It serves as an information resource, a clearinghouse to match up patients with scalp cooling centers and financial aid, and also donates biomedical freezers to hospitals for freezing and storing cold caps.8

HairToStay Scalp cooling can cost upwards of $1000 per patient, approximately the same as a custom made wig. Insurance may not pay for it; however, there is an organization that subsidizes the cost for many people. HairToStay is a national nonprofit dedicated to providing financial support to patients who cannot afford scalp cooling. According to executive director Bethany Hornthal, some patients refuse chemotherapy for fear of losing their hair; the caps offer a solution. HairToStay, which is sustained by donations, is also focused on educating and supporting patients with cancer, networking to salons, and expanding awareness of scalp cooling in the United States.9


1. Rugo HS, Klein P, Melin SA, et al. Clinical performance of the DigniCap System, a scalp hypothermia system, in preventing chemotherapy induced alopecia. J Clin Oncol. 2015;33(suppl):Abstr 9518.

2. Cold caps (scalp hypothermia). American Cancer Society web site. Accessed November 18, 2016.

3. Cigler T, Isseroff D, Fiederlein B, et al.  Efficacy of scalp cooling in preventing chemotherapy-induced alopecia in breast cancer patients receiving adjuvant docetaxel and cyclophosphamide chemotherapy. Clin Breast Cancer. 2015;15(5):332-4.

4.  Komen MM, Smorenburg CH, van den Hurk CJ, Nortier JW. Factors influencing the effectiveness of scalp cooling in the prevention of chemotherapy-induced alopecia. Oncologist. 2013;18(7):885-891.

5.  Cold caps. web site. Accessed November 18, 2016.

6. Paxman. Accessed November 18, 2016.

7. DigniCap. Accessed November 18, 2016.

8. The Rapunzel Project. Accessed November 18, 2016.

9. HairToStay. Accessed November 18, 2016.

Revised December 6, 2016.