The device that could help save your hair during chemo

January 23, 2019 Providence Health Team

Cold cap treatment helps preserve hair during chemotherapy for breast cancer.

The treatment freezes hair follicles so they aren’t impacted by chemotherapy.

It’s crucial to ensure proper technique when putting on the cap to prevent hair loss.

There was a woman who was passionate about her career and extremely self-sufficient. When she was diagnosed with breast cancer, she didn’t want to lose her autonomy. She was fearful that if she disclosed her disease to her colleagues, she would be viewed as a “patient” who couldn’t handle her workload, and she worried that hair loss caused by chemo would give away her secret. As it turned out, she successfully completed chemotherapy and continued working, ultimately telling her coworkers about her condition — on her terms, as a survivor. That’s because she used a cutting-edge device called a cold cap to prevent hair loss.

“The cold cap treatment is all about providing patients a sense of control and a way to preserve their normalcy by retaining their hair,” says David Page, M.D., a medical oncologist with the Providence Cancer Institute Franz Clinic in Portland, Oregon.

Hair loss is a considerable concern for women dealing with breast cancer. There are about 240,000 women with breast cancer in the United States each year, and about a third of them need chemotherapy to treat their cancer. The vast majority of chemotherapy options cause women to lose their hair entirely.

“The hair loss is quite abrupt. People start to lose their hair in chunks about two to three weeks after therapy, so it’s very traumatic for the patient. It’s often described as a loss of the sense of control, which is the most anxiety-provoking thing,” Dr. Page says. “It’s also an externalization of their diagnosis. When patients walk down the street, people see they are bald and ask what’s going on, so the patient has to divulge their diagnosis.”

How the cold cap treatment works

The cold cap is a mechanical device that is similar to a helmet. Its primary purpose is to lower the temperature of the hair follicles before, during and for a brief period after chemo.

“The thought is that it makes the hair follicle dormant so when chemo is coursing through the veins the chemo doesn’t affect the hair follicle as much as it would otherwise,” Dr. Page says. “Chemo kills cells in the body that are trying to divide and grow. If the hair follicle is made dormant and it’s not dividing and growing, the follicle may not lose its hair.”

The patient purchases cold caps through the manufacturer, with three to four caps included in each order. To chill the caps, the patient puts them in a cooler with dry ice. The caps are filled with an insulating gel that freezes to subzero temperatures.

When it’s time for chemo, a patient takes the cooler to the infusion appointment. The first cap is put on at least 30 minutes before the beginning of the chemo session; to retain the proper degree of coldness over time, the caps are switched out every 30 minutes. For maximum effectiveness, the caps should be worn at least four hours total. That’s because there is still a high concentration of chemo in the body during that time.

Properly fitting the cap on the patient’s head each time is crucial to a successful outcome. “You have to ensure a very good fit onto the scalp because you need those subzero temperatures to protect the hair follicles,” Dr. Page says. “The technique is the most important factor of success. If someone is careless about placing the cap on the head, the patient may lose hair on certain parts of the head.”

This process can be difficult for a patient to do on her own, so a family member is usually enlisted to help out. Usually, patients and their families learn how to put the cap on by watching YouTube videos.

“There is something to be said for the families, friends or loved ones coming together to help the patient with this process of retaining her hair,” Dr. Page says. “It’s special. It can potentially help improve the quality of life for patients and their families, and it gives them a sense of purpose to fight their cancer head on. And it might not necessarily be a bad thing that there is extra work involved because the alternative is to just lie idle while getting chemo. Passivity can feel objectifying to the patient, as compared to somebody who is being more proactive.”

Cold cap results and other effects

Cold cap treatment can work well for patients whose chemotherapy causes hair loss and is administered at an intermediate level of intensity. Dr. Page says. If the proper technique is used, more than half and closer to 100% of patients can retain their hair. Results are less clear for patients who require more intense chemo; Dr. Page estimates that at least half of the clinic’s patients in this group have retained their hair. Generally, cold caps aren’t recommended for patients whose chemotherapy doesn’t cause a lot of hair loss. “It’s a lot of work if there is a chance the patient will keep her hair anyway,” Dr. Page says.

When it comes to hair retention, it’s observed across a spectrum. Dr. Page adds that he has seen some patients experience only minimal hair loss and some patients with extremely thick hair whose thinning wasn’t noticeable. There are patients who have substantial hair loss due to intense chemo and others who have lost patches from improperly fitted caps; some patients experience a general thinning. Even with hair loss, cold cap treatment can still be valuable, Dr. Page says.

“These patients often say it was worthwhile because their hair starts to regrow and even after a couple of months of regrowth there is enough coverage of the thin spots that their hair looks relatively normal. The casual observer would not know that they just had chemo,” he says.

There are some symptoms involved in the cold cap process. They can include discomfort, pain and a cold feeling all over the body as a result of freezing the follicles on the head. “What I can say is that the body adapts during the first couple of exchanges of the cold caps,” Dr. Page says. “You actually stop feeling pain and the intense cold after the first hour or so. I have not had one patient who had to stop treatment because of pain. It’s more of an adjustment period.”

Another possible effect isn’t physical, but financial. The price is upward of several thousand dollars, which can include renting the caps and buying dry ice. However, Dr. Page says there is a national philanthropic fund called the Rapunzel Project that can potentially subsidize the cost.

Because cold cap treatment is patient-initiated, physicians should accommodate anyone who wants to use it, depending on the type of chemo involved. “It should always be an option,” Dr. Page says.

For more information on cold cap treatment, visit the Rapunzel Project. To learn more about cancer treatments and services at Providence, visit or one of the following websites for a location near you:

OR: Providence Cancer Institute

AK: Providence Cancer Center

WA: Providence Regional Cancer System; Swedish Cancer Institute; Kadlec Oncology Program; Pacific Medical Centers; Providence Regional Cancer Center

CA: Providence Health & Services, Southern California; St. Joseph Health Medical Group; St. Joseph & St. Jude Heritage Medical Group

MT: Montana Cancer Center at Providence St. Patrick Hospital

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This information is not intended as a substitute for professional medical care. Always follow your health care professional's instructions.

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