Cooling Caps Reduce Chemotherapy-Related Hair Loss

Although scalp-cooling caps reduce hair loss, insurers do not cover the treatment.

Recent clinical studies have found that the use of a scalp-cooling cap may reduce hair loss resulting from chemotherapy in patients with breast cancer. Cooling is believed to prevent hair loss by reducing blood flow to the hair follicles.

In a set of studies published by JAMA, the authors found that 5% of patients who wore the cooling cap did not lose any hair during treatment.

Approximately 50% to 60% of patients lost less than 50% of their hair, while control patients who did not wear the cooling cap lost approximately 50% or more of their hair, with some losing nearly all of their hair.

These findings led researchers to advocate for the use of scalp-cooling caps for patients with breast cancer undergoing chemotherapy. However, paying for this new technology may be complicated.

“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,” oncologist Dawn Hershman, MD, wrote in a JAMA editorial article. “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 breast cancer.”

Currently, the scalp-cooling devices are available for use in Europe and in some institutions in the United States.

While chemotherapy is often a first-line therapy option for patients with breast cancer and can reduce the risk of mortality up to 35%, a recent study found that 8% of patients may avoid the treatment due to perceived hair loss risks.

“The medical community has gone to great lengths to reduce the risk of side effects—such as nausea, fever, early menopause, and even infertility—that may interfere with the initiation or continuation of breast cancer chemotherapy,” Dr Hershman said. “But when it comes to preventing significant hair loss, we have made very little progress.”

Scalp cooling is believed to reduce blood flow and chemotherapy drugs to the hair follicles, and prevent hair loss. Patients undergoing chemotherapy wear the cap during the treatment and for 90 minutes post-treatment, according to the article.

The cost of the device depends on the duration of chemotherapy and the type of cap that is used, with an average range from $1500 and $3000. Additional costs may be incurred due to extended time in the infusion center and personnel costs, according to the article.

Unfortunately, scalp cooling is not covered by insurance, despite its benefits. If there are substantial out-of-pocket costs for the treatment, patients may not choose to receive scalp cooling treatment.

At one time, breast reconstruction after mastectomy was also not covered by insurance because it was believed to be a cosmetic procedure. Dr Hershman is hopeful that insurers will see that the benefits to scalp cooling go beyond cosmetic reasons.

“Reassuring patients that symptoms can be controlled may help persuade them to initiate treatment and may lead to improvements in quality of life and survival,” Dr Hershman concluded.