Cold cap therapy has been in the news lately, due to a new New York State law requiring insurance coverage for scalp cooling devices, making this treatment option more accessible to patients. Signed into effect on December 19, 2024 this law marks a significant step forward in patient care and support.

Scalp cooling therapy, also known as cold cap therapy, cold capping, a chemo cap, or scalp hypothermia, is an innovative treatment option helping cancer patients reduce hair loss during chemotherapy, but it comes with added time, costs, and potential discomfort. Understanding the process, how it works, its benefits, side effects and insurance options can help you make an informed decision.

How Scalp Cooling Works

Chemotherapy targets fast-growing cells, including both cancer and hair follicle cells, leading to hair loss, also called chemotherapy-induced alopecia (CIA). Scalp cooling helps by lowering scalp temperature, which slows blood flow to the area. With less blood flow, fewer chemo drugs reach hair follicles, reducing damage. Patients wear a silicone cold cap attached to a cooling system that keeps the scalp at 64-72ºF. This cooling effect can help prevent or lessen hair loss during treatment.

What Is Scalp Cooling?

There are two primary types of scalp cooling methods: automated and manual.

• Automated systems use FDA-regulated machines to circulate a cooled liquid through a cap, maintaining a consistent temperature. These systems, such as DigniCap, Paxman, and Amma, are approved for patients undergoing chemotherapy for solid tumor cancers.
• Manual scalp cooling, on the other hand, relies on frozen gel caps that must be pre-cooled using dry ice or a freezer. Since these caps begin warming as soon as they are applied, they must be replaced every 30 minutes to remain effective. While manual cooling is more affordable, it lacks FDA approval and is often not covered by insurance.

Who Is Scalp Cooling Unsuitable For?

Not everyone is a good candidate for scalp cooling. Doctors consider several factors, such as cancer type, chemotherapy regimen, age, and existing medical conditions. Scalp cooling can benefit many cancer patients, including those with breast cancer, bladder cancer, colorectal cancer, and prostate cancer. However, it may not be suitable for everyone, including those who:

• Are undergoing immunotherapy or targeted treatments
• Have severe liver or kidney disease
• Have or may develop scalp metastasis
• Are under 18 years old
• Have head or neck cancers
• Have blood cancers such as leukemia, lymphoma, or non-Hodgkin lymphoma
• Will receive bone marrow ablation chemotherapy
• Have cancer affecting the central nervous system
• Have cold sensitivity or conditions triggered by cold temperatures
• Have skin cancers, including melanoma, squamous cell carcinoma, or Merkel cell carcinoma
• Are undergoing radiation therapy to the skull
• Have squamous cell carcinoma of the lung or small cell lung cancer

Benefits of Scalp Cooling

Scalp cooling helps cancer patients keep their hair, providing comfort and confidence during treatment. Many find it fosters normalcy and makes their cancer journey easier. Benefits include:

• Privacy – Helps keep a cancer diagnosis private
• Emotional well-being – Reduces distress for young children and family members
• Sense of control – Maintains a feeling of autonomy during treatment
• Identity preservation – Keeps a part of one’s personal image intact
• Confidence boost – Supports self-esteem and mental and emotional wellness
• Reduced visibility of illness – Helps patients feel more like themselves

What Are the Side Effects & Downsides of Cold Caps?

While scalp cooling can help preserve hair, it also has some short-term side effects. Patients may experience discomfort or temporary symptoms, including:

• Chills – Feeling excessively cold during treatment
• Headaches – Mild to moderate pain in the head
• Dizziness – Lightheadedness or balance issues
• Nausea – A queasy stomach sensation
• Numbness – Reduced sensation on the scalp
• Burning sensation – Tingling or warmth in the scalp area
• Sinus pain – Pressure or discomfort in the sinus region

Patients considering scalp cooling should also think about practical factors. The process may require extended time at the infusion center, including post-cooling sessions. Asking yourself whether preserving hair is a priority and if you can manage the extra time commitment can help determine if scalp cooling is right for you.

What To Expect During Your Treatment

Patients choosing scalp cooling will be custom-fitted for a cooling cap before starting chemotherapy. This cap is worn at every treatment session and requires proper preparation. Hair should be washed with a gentle, paraben-, sodium larel sulfate- and silicone-free shampoo the day before or on the day of treatment, and no hair products should be applied.

Since scalp cooling extends chemotherapy appointments, patients should be prepared for extra time at the infusion center. The process adds about 1.5 to 2 hours per visit, including pre- and post-cooling periods. A typical session involves:

• Hair preparation – Patients wet their hair, apply conditioner, and brush it back before putting on the cooling cap.
• Pre-chemotherapy cooling – A cooling cap is worn for at least 30 minutes before chemotherapy begins.
• Chemotherapy – The cap remains in place throughout the infusion process.
• Post-chemotherapy cooling – Patients continue wearing the cooling cap for up to 90 minutes after treatment ends.

Does Insurance Pay for Cold Capping?

While many insurance providers, including Medicare and Medicaid, now cover scalp cooling, for most people, scalp cooling therapy remains an out-of-pocket expense.

In New York, a new law passed in 2024 requires large private insurers to provide coverage. Some private plans and health savings accounts may also cover costs, so checking with insurers is essential.

For those without coverage, financial aid is available. HairToStay helps low-income patients fund treatment, while The Rapunzel Project provides guidance on other support options. Exploring these resources can help determine affordability.

Do You Need Support for Your Chemotherapy Journey?

Navigating insurance coverage can be overwhelming, but our patient navigators are here to help. SHAREing & CAREing provides assistance with paperwork, pre-authorizations, claim submissions, and appeals. No matter your insurance status, our mission is to ensure that all Queens and New York City residents receive the cancer care they need. Contact us anytime for individual support, join our monthly in-person support group in Astoria, or sign up for our newsletter to stay informed about cancer support resources and upcoming events.

Sources

• Cold Caps to Reduce Chemo Hair Loss, UCSF Health
• Cold Caps and Scalp Cooling Systems, American Cancer Society
• Senator Stavisky/Assemblymember Rosenthal sponsored legislation benefiting New Yorkers battling cancer is signed into law, NY State Senate
• Cold Cap Therapy, University of Maryland Medical System
• Scalp Cooling and Chemotherapy Hair Loss: What to Know, MD Anderson Cancer Center