Scalp Cooling May Help Chemo-Induced Hair Loss for Certain Cancers

Scalp cooling may help reduce chemotherapy-related hair loss in certain patients with cancer.

Hair loss is common among patients with cancer receiving chemotherapy. However, with scalp cooling, patients with cancer may be able to reduce the amount of hair that is lost.

Scalp cooling is a type of intervention for patients with cancer receiving chemotherapy, depending on their cancer type, Dr. Stephen Kimani said during an interview with CURE®. Kimani is a breast medical oncologist at the University of Utah Huntsman Cancer Institute.

“Scalp cooling basically refers to a technique to lower the temperature of the blood flow to the scalp area,” Kimani explained. “This is mostly intended to decrease the amount of hair that patients can lose during chemotherapy.”

Chemotherapy treatments for cancer, including breast cancer, are considered cytotoxic chemotherapy. This chemotherapy treatment works by “killing rapidly dividing cells that tend to be preferentially cancer cells,” Kimani said. But the treatment works at trying to kill other normal cells that are also constantly dividing to generate new cells.

“The hair on the scalp area has a lot of hair follicles, so scalp cooling is meant to lower the temperature [and] decrease blood flow to the scalp, which [reduces] how much chemotherapy gets to those dividing [cells],” Kimani added. “Therefore, [scalp cooling] protects [these dividing cells] from getting damaged, allowing for either quicker recovery after finishing chemotherapy or even less amount of hair that’s lost.”

How Successful Scalp Cooling is in Reducing Chemotherapy-Induced Hair Loss

The success of scalp cooling in patients experiencing hair loss from chemotherapy depends on three main factors, Kimani noted. These factors include:

• The type of chemotherapy regimen that patients receive
• How frequently the doses of chemotherapy are received
• Patients’ specific characteristics and hair characteristics

“When we think about the effectiveness of [scalp] cooling in preventing or decreasing the severity of health, all those factors come into mind,” he explained. “The data we have is mostly robust for [patients with] breast cancer, [which] predominantly affects women. Hair is a big drive of self-image and body positivity. So, [scalp cooling has] been an area of intense focus for years.”

Even with scalp cooling, hair loss still occurs, just to a lesser degree, Kimani emphasized.

“Depending on the type of regimen (combination of chemotherapies), the benefit can be significantly more or significantly less,” he said.

Two main regimens that are used in breast cancer include taxane-based chemotherapy (which prevents cancer cells from replicating) and anthracycline-based chemotherapy (binds to DNA in cancer cells to prevent replication), Kimani explained.

“The effectiveness is very high for those who receive taxane-based chemotherapy without an anthracycline and that's usually the majority of [patients with] breast cancer,” he said. “In that group, we noticed that … patients who reported mild to moderate hair loss was more than 60% compared to patients who reported severe hair loss, which was less than a third in the anthracycline group. So, effectiveness is varied depending on the regimen.”

Eligibility for Scalp Cooling for Patients With Cancer

Knowing whether patients with cancer are eligible for scalp cooling also depends on several factors, such as how long they have had cancer and their cancer type, Kimani noted.

“I encourage patients to always ask their doctor if they are eligible for scalp cooling and for several reasons,” he said. “One is when we see patients who have just had a diagnosis of cancer, the focus might be more on trying to treat and fight the cancer, rather than in the supportive interventions that we know are important for the patient experience, but also for mental health.”

Nevertheless, certain patients may not be eligible, depending on their cancer type, Kimani mentioned.

“Those [patients] are easier to define upfront. For example, those are patient who might have blood cancers. So leukemia or lymphoma [is when the] blood cells are now cancerous [and are] circulating everywhere,” he explained. “So, [patients] don’t want to take the chance of minimizing the effectiveness of chemotherapy by cooling the scalp because there’s a chance that the cancer cells — which is in the blood — are already there. That’s a group that normally we encourage [patients] not to consider scalp cooling.”

Another population of patients who may not benefit from scalp cooling are people undergoing radiation treatment for brain cancer or for cancers that have spread to the brain. Two reasons include uncomfortableness with scalp cooling when patients have brain tumors and because scalp cooling may interfere with the effectiveness of the radiation treatment, Kimani said.

Some patients who receive chemotherapy intravenously (IV; through the vein) for long periods of time may not be eligible for scalp cooling.

“For certain types of cancer where people are receiving IV chemotherapy for a long time, and we have infusions that run 24 hours or longer, it’s not ideal to consider scalp cooling because it can be uncomfortable to wear a cold cap for 24 hours or longer,” he explained.

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