What is Scalp Cooling/Cold Cap Therapy?

Scalp Cooling, or Cold Cap Therapy, involves the use of a special cap or set of caps, cooled to very cold temperatures, and worn for a period of hours before, during and after each chemotherapy treatment. The cold temperature constricts the blood vessels leading to the hair follicles, reducing the amount of chemo drugs that reach the follicles during the period that the cap(s) is/are worn; also, the cold puts the follicles "to sleep," temporarily limiting their metabolic activity. (Of note, the drugs stay in the patient's system far longer, but reach the hair follicles when they are at somewhat diluted strength.) This process has been in use in Europe for over 25 years. Hundreds of thousands of patients in the United States have learned of and successfully used Scalp Cooling/Cold Cap Therapy in the last decade.

Recent editorials in the Journal of the American Medical Association support the use of Scalp Cooling machines.

According to editorials in the Journal of the American Medical Association (JAMA, February 2017), a majority of patients consider hair loss to be the most dreaded aspect of chemotherapy, and some fear losing their hair so much that they decide to forego chemotherapy entirely.

Addressing this concern, two Scalp Cooling solutions, the DigniCap® and the Paxman Scalp Cooling System, which have both shown solid results in the fight against chemotherapy-induced alopecia, have now received FDA clearance.

These two JAMA editorials cite the clinical trials results for one or both of these systems (see the Trials and Research page of this website for details), and both agree that there is sufficient evidence of the efficacy of these scalp cooling systems to warrant far more widespread usage. This is particularly compelling because the use of scalp cooling devices reduces or eliminates an extremely distressing side effect of chemotherapy.

The first editorial, “Scalp Cooling to Prevent Chemotherapy-Induced Alopecia: The Time Has Come” by Dawn L. Hershman, M.D., MS, concludes, “Chemotherapy has been a mainstay of adjuvant therapy for breast cancer and has contributed to a reduction in breast cancer-related mortality. However, with the introduction of targeted therapies, it is appealing to imagine a future in which chemotherapy is no longer necessary and some of the distressing adverse effects of cancer treatments can be avoided. Until that time, identifying interventions, such as scalp cooling for the prevention of chemotherapy-induced alopecia, that reduce or eliminate treatment-associated toxic effects will help ease the distress associated with chemotherapy and may, as a result, improve outcomes for patients with cancer.”
In the second editorial, “Do the Data on Scalp Cooling for Patients with Breast Cancer Warrant Broad Adoption?” by Howard (Jack) West, M.D., West also focuses on the conclusions from one of the clinical trials.


West lauds the evidence showing that treatment now has the potential to render hair loss among cancer patients a less common occurrence and believes that frequent use and more research will continue to make Scalp Cooling systems more effective.

The Rapunzel Project couldn’t say it any better — “THE TIME HAS COME.”

The Oncology Nursing Society, in its Clinical Journal of Oncology Nursing, has also published articles supporting the use of Scalp Cooling technology.

The support of oncology nurses for the scalp cooling process is critically important. Nurses administer chemotherapy to patients, and they understand the anguish caused by hair loss. Two 2017 articles in the Clinical Journal of Oncology Nursing identify that hair loss is the most feared side effect of chemotherapy for as many as 75% of patients, and that machine scalp cooling (or manual cold caps) offers the best available option for mitigating this problem.

In "Scalp Cooling, a literature review of efficacy, safety, and tolerability for chemotherapy-induced alopecia" by Mikel Ross, BSN, RN, OCN, CBCN, and Erica Fischer-Cartlidge, MSN, CNS, CBCN, AOCNS, April 2017, the authors reviewed 40 years of studies and literature on the topic. They concluded "patients who use scalp cooling have better (hair) preservation than those who do not, despite variability in study design, populations, treatments, and outcome measure". They found tolerability high overall, and most importantly, that "the incidence of scalp metastases is low, and scalp cooling is unlikely to adversely affect their occurrence".


The authors concluded with some implications for practice, which we found extremely compelling.

  • Encourage more use of scalp cooling to help reduce CIA, based on its overall positive effect, and because of the success it has had as a supportive care intervention in Europe and Canada and its increasing attention in the United States.
  • Learn more about scalp cooling to help advance practice changes based on evidence by dispelling existing myths, providing evidence-based education, and advocating for universal access at a reasonable cost".
The second article, "Scalp Cooling, the prevention of chemotherapy-induced alopecia" by Anne Katz, PhD, RN, FAAN, August 2017, also reported on a review of the literature. She additionally addressed some of the practical considerations for oncology nursing, including time required to give patients hair care instructions, preparation time for treatment, and additional chair time needed for post infusion scalp cooling. The author concluded that "...using this procedure appears to afford some protection against hair loss, albeit with increased nursing resources and chair time. Perhaps what this procedure offers with greater certainty is hope that hair loss can be prevented and, along with it, less distress and alterations in body image and quality of life for survivors."

We are thrilled to see editorial support for Scalp Cooling Therapy. The concept of "freezing the head" has been around since the 1970's. Technology and practice have finally evolved to a point where there are tangible benefits for solid tumor patients. All eligible patients should know there is an option that could allow them to save most of their hair during chemotherapy. In addition to awareness and accessibility, affordability must also be addressed as soon as possible.

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