If you're facing chemotherapy, someone has probably mentioned the cold cap by now. It might have been your nurse, a friend, or a stranger on a forum at two in the morning.
What you likely haven't been given is a straight answer about whether it's worth it. Here's one, as honestly as we can put it. We sell hats and scarves, so we have no stake in whether you cold cap or not, and we're not medical people. Your chemo team is the one to ask about the medical bit when it comes to the specifics of your treatment.
What is scalp cooling during chemotherapy treatment?
Cooling your scalp tightens the blood vessels in it, which reduces how much blood flows to your hair follicles. Less blood means less chemotherapy drug reaching them, and the follicles have a better chance of surviving.
You'll come across two versions.
Machine systems like Paxman circulate coolant through a fitted cap connected to a small machine. You sit beside it for the duration. Most UK hospitals that offer scalp cooling use one of these.
Gel caps are frozen in advance and swapped over every 20 to 40 minutes to keep the temperature down. They're heavier, and someone needs to be on hand to change them.
Does it work?
Sometimes very well, sometimes not at all, and the honest answer is that nobody can tell you in advance which you'll be.
Success is usually measured as keeping enough hair that you don't need a wig. On that measure, success rates of around 50 to 70 per cent get quoted for the regimens it suits best. Paxman puts it at up to 70 per cent retention for some chemotherapy combinations, and lower for others.
The thing that matters most is which drugs you're having. Scalp cooling tends to do best with taxane-based treatment. It does considerably less well with anthracyclines, and with some regimens it isn't offered at all because there's little point.
Ask your chemo nurse what the realistic odds are for your specific treatment. They'll know, and a good one will tell you straight.
Will I lose hair using a cold cap?
This is the part people aren't prepared for, and it's why so many give up after round two.
You will lose some hair even if the cap is working well. Shedding usually starts around day 14 to 21 after the first session, exactly the same as if you weren't cold capping. For some people it's barely noticeable, for others it's a lot, and it feels like proof the whole thing has failed.
It often isn't. Without the cap you'd probably have lost most of it - thinning is a different outcome to losing the lot.
What does a cold cap feel like?
Cold. Properly, genuinely cold, and the first ten to fifteen minutes are the worst of it. Most people say it settles into something manageable after that as the scalp goes a bit numb.
Headaches are the most common complaint. Some people get through with paracetamol, some find it fine, and a few decide it isn't for them.
The other cost is time. Scalp cooling adds a fair bit to every appointment, because the cap goes on before treatment starts and stays on for a while afterwards. Depending on your regimen that can add one to two hours each visit.
Practical things that help:
- Take a blanket, and expect to be cold all over rather than just your head
- Wear layers you can add
- Bring hot drinks and something to keep your hands warm
- Take painkillers with you in case of a headache, having checked with your team first
- Plan your day around the extra time and don't book anything afterwards
When is a cold cap not suitable?
Scalp cooling isn't right for everyone, and hospitals have their own criteria. It's generally not offered if you already have total hair loss, if you have a wound on your scalp, or if your chemotherapy continues at home through tablets or a pump, because the cooling only works while the drug is going in.
If you get frequent headaches, some units will advise against it. Certain blood cancers are also excluded, but your team will advise you based on your combination of drugs.
Is the cold cap available to all chemo patients?
Not every hospital has it. Machine systems are expensive, and units have a limited number, so some run a waiting list or offer it only for certain regimens.
Where it is available on the NHS, it's usually free. Some patients fund their own gel caps privately where the hospital can't provide a system, though you'll need your unit's agreement and somewhere to freeze them.
Ask early about a cold cap, ideally before your first session because it needs a bit of organising.
Looking after your hair during treatment
Your team will give you specific instructions and their advice definitely will take priority over mine, but broadly, you need to be very gentle with your hair when using the cold cap:
- Wash no more than about twice a week
- Use lukewarm water and a very mild shampoo
- No hairdryers, straighteners, tongs or heated rollers
- No dye, bleach, perms or chemical straightening
- Use a wide-tooth comb or a soft brush and go slowly
- Skip tight ponytails, clips and grips
If you have Afro hair, weaves and braids need to come out before you start, and your unit can advise on the best way to prepare.
There's more on keeping your scalp comfortable in our guide to scalp care during chemotherapy.
One thing worth knowing about afterwards
Even where scalp cooling doesn't save much hair, there's reasonable evidence it helps regrowth come back faster and stronger afterwards. Several people have told us their hair returned quicker than they expected and they put it down to the cap.
That's a genuine benefit, and it doesn't get mentioned enough when people are weighing it up.
Have a chemo hat either way
This is the practical bit we'd say to anyone considering it.
Even a successful cold cap usually leaves you thinner than you were. Plenty of people who keep most of their hair still want something to cover a visible parting, and a soft chemo hat or a head scarf does that without any fuss.
You'll also be colder than usual. Between the cap itself and a thinner covering, a lot of people find they want something soft to sleep in for the first time in their lives.
Having one in the drawer costs little and takes a decision off your plate on a bad day.
The decision
Nobody can promise you it'll work. What you're weighing up is a decent chance of keeping enough hair to feel like yourself, against colder, longer, more uncomfortable treatment days.
Some people try it, hate it, and stop after one round with no regrets. Others say it was the thing that got them through, because they could take their children to school without anyone knowing.
Both opinions are entirely reasonable, afterall, it's your head and your treatment, and whichever way you go, nobody gets to tell you that you chose wrong.
Frequently asked questions
Does the cold cap really work? For some people, yes. Success rates of roughly 50 to 70 per cent hair retention are quoted for the chemotherapy regimens it suits best, though results vary a lot by drug. It works better with taxane-based treatment than with anthracyclines.
Is scalp cooling available on the NHS? Many UK hospitals offer it and it's usually free where available, but not every unit has a system. Ask your chemo nurse before your first session, since the cap needs to be used from the very first round.
Does the cold cap hurt? It's very cold, and the first ten to fifteen minutes are hardest. Headaches are the most common side effect. Most people find it settles into something manageable after the initial shock.
Will I still lose hair with a cold cap? Almost certainly some. Shedding typically begins two to three weeks after the first session whether you cold cap or not. Thinning doesn't mean the cap has failed.
How much longer does chemo take with scalp cooling? Usually one to two hours extra per session, because the cap goes on before treatment and stays on afterwards. Your unit can tell you the timings for your regimen.
Not medical advice. Whether scalp cooling suits you and your treatment is a question for your oncology team.
