Scalp cooling can prevent hair loss

Survivors describe hair loss as one of the most disturbing and/or feared side effects at the start of chemotherapy. Despite alternatives such as a wig or a scarf, hair loss has a major impact on many women’s self-image. Women indicate that they suddenly see themselves as 'cancer patients' and are often concerned that the outside world sees it that way too. As a result, hair loss not only has an emotional impact but also has a major impact on their social lives, both inside and outside the household. Contrary to what is generally assumed, male survivors experience the same negative feelings about their hair loss following chemotherapy.

Is scalp cooling a new technique?

The principle of scalp cooling has been around for several decades but was not easily introduced in hospitals. Earlier cooling systems had worse results and were more difficult for patients to tolerate. The lack of long-term experience with scalp cooling was (rightly) a barrier to its introduction. In recent years, scalp cooling is gaining more attention thanks to new scientific insights into the effectiveness of scalp cooling in certain treatments and its long-term safety. The development of better instruments that give better results and are more tolerable has also contributed to this.

How can scalp cooling prevent hair loss?

Cooling the scalp during chemotherapy can prevent or reduce hair loss. This is because the cooling leads to narrowing of the blood vessels in the scalp, which reduces the amount of chemotherapy that reaches the hair roots and, therefore, damages them less.

Does scalp cooling work?

The results are very variable. The way in which scalp cooling is done is an important factor. Newer scalp cooling devices provide constant cooling, which in recent years has led to better results and a more bearable treatment.

But the chances of success of scalp cooling also differ greatly from patient to patient and, to a large extent, depend on the type and dose of chemotherapy. In some treatments, scalp cooling can prevent complete hair loss in more than 70 % of patients. This means that, thanks to scalp cooling, they do not have to wear a wig or other headgear. In other treatments, the chances of success are (far) below 50 %.

Finally, it is important for patients to know that scalp cooling cannot prevent all hair loss or thinning, even in treatments with good success rates. Light or moderate hair loss can occur. This does not necessarily mean that the cooling does not work.

How does scalp cooling work?

The nurse applies a scalp cooling cap to the head. This cap is connected to a cooling device via tubes. The cap itself is cooled to -5 to -6 °C and, therefore, the temperature of the scalp is lowered to approximately 18 °C. Chemotherapy starts 30 minutes after the cap has been placed. This phase is also called pre-cooling. During the application of chemotherapy, the cap remains in place. After having received chemotherapy, the cooling continues. This takes 20 to 45 or (often) 90 minutes, depending on the type of chemotherapy. All in all, scalp cooling takes two hours longer than chemotherapy without cooling.

Is scalp cooling difficult to bear?

The tolerability of scalp cooling has improved significantly thanks to newer devices. The worst cold is felt in the first 10 to 15 minutes after the cooling has started. This can be accompanied by a light feeling in the head and headaches. After a 15-minute period, your body will be able to tolerate the cold better. In case of persistent pain, a simple painkiller can help. 80 % of patients do not have headaches. Less than 10 % drop out because of poor tolerance.

Does every hospital offer scalp cooling?

Scalp cooling is not offered in every hospital yet. The devices are very expensive and scalp cooling requires nursing time as well as organisational adjustments. At the moment, health insurance only provides compensation for the purchase of a wig and no refund for scalp cooling. Despite the large investment, hospitals offer scalp cooling free of charge.

Can all survivors get scalp cooling?

In almost all hospitals, the answer is 'no'. Firstly, there are contraindications. Scalp cooling is not recommended for people with cold allergies, blood disorders, skin cancer or metastases near the skin. In addition, the majority of hospitals only offer scalp cooling for a selective number of treatments. In other words, scalp cooling is only offered for treatments where scalp cooling offers good chances of hair preservation.

In UZ Leuven and in several other hospitals, scientific indications about the success rate of scalp cooling determine when scalp cooling is offered. Every patient within the agreed target group is offered scalp cooling. The patient then chooses whether they wish to accept this offer.

By: Annemarie Coolbrandt 
Nursing specialist in oncology, UZ Leuven 

Through the SMART Fund, Think Pink has been supporting scientific research into scalp cooling at UZ Leuven and CHU UCL Namur for two years. The aim of the research is to study in which circumstances scalp cooling works best and to investigate the cost of the equipment and of time investment. With a realistic picture of their own country, researchers and Think Pink want to build a case for the essential refund by social security.