One of the most common side effects of certain breast cancer treatments is hair loss (alopecia). This can be very distressing for patients and may lead to negative self-image and feelings of depression or anxiety. To help reduce chemotherapy induced hair loss there is a treatment that can be used called scalp cooling.

What is Scalp Cooling and how does it work?

Scalp cooling works by lowering the temperature of the scalp before, during and after each chemotherapy treatment.
The scalp cooling machine is designed to circulate a cold gel around a tight-fitting cap that is worn during each chemotherapy treatment.

TREATMENT TIME

The time for your treatment will increase when you use scalp cooling and will add up to two and a half hours in addition to the chemotherapy treatment time.
The Scalp cooling starts 30-minutes before the chemotherapy infusion, stays on during chemotherapy and for 90-minutes after chemotherapy ends.

FITTING OF THE SCALP COOLING CAP

It is essential that the cap fits tightly over your head, making sure that the cap fits along the hair line and that there are no gaps between the cap and the scalp.

If your cap does not fit well the cap size may need to be changed. Cooling caps that are not fitted tightly have been linked with more hair loss, often in patches where contact with the scalp is poor. If you do not feel your cap is fitted properly, ask your nurse to check the fitting.

USING THE BATHROOM DURING SCALP COOLING

During your scalp cooling treatment, you are somewhat restricted from moving around. However, if you need to go to the toilet, the cooling cap will be disconnected from the cooling machine.

When you first stand up, you may feel dizzy, so it is good to have a friend, or a nurse walk to the bathroom with you.

Keep in mind that while you are not connected to the machine, the cooling cap will warm up. If this is less than 15 minutes, it shouldn’t affect hair loss.

TO CUT OR NOT CUT YOUR HAIR

Some women with long hair may decide to have their hair cut to shoulder length as they feel that the cap fits better. However, there is no evidence that the results of scalp cooling are better if the hair is short.

SIDE EFFECTS OF SCALP COOLING

The scalp cooling cap will feel very cold when it is first put on and takes around 5 – 15 minutes for your body and scalp to get used to the level of coldness. Some women experience the feeling of cold for the entire treatment session.

The cooling cap is fitted tightly, and this can cause discomfort during and after treatment.

You may experience headaches/migraines, feeling faint, dizzy, and nauseous.

The chin strap may also cause you some discomfort.

Hair Loss During Scalp Cooling Treatment

People who use scalp cooling may still experience hair loss ranging from hair thinning to loss of 90% of their hair. There are different reasons for this, including the type of chemotherapy treatment and the woman’s hair type.

When effective, scalp cooling can lower the degree of significant hair loss, such that they did not need to use a wig or hair covering. Most hair loss occurs after the first two sessions of chemotherapy.

A study carried out by the Breast Cancer Research Centre–WA identified that many patients expressed their satisfaction with being offered an intervention to minimise hair loss, thus, the majority of patients studied were satisfied with use of SC and would elect to use it again, irrespective of how effective the device had been.

Further, our study provided the percentage likelihood of retaining more than half of hair volume based on the chemotherapy regimen that women were recommended for. Thus, providing women with information as to whether they wish to use the device or not once they know which chemotherapy they are to receive.

Being as prepared as possible before and during scalp cooling treatment

• Wash your hair prior to the day of your scalp cooling treatment as oily hair may affect the scalp cooling process. Depending on your hair type, you may need to apply hair conditioner to help with cap application and removal. Conditioner may also help reduce tangling of your hair.
• Bring extra clothing/layers that you may choose to wear during your treatment, such as jumpers, cardigans, socks, and gloves. Also, bring a hat or head scarf with you to the hospital ready to wear when you go home. You can ask your nurse for a warm blanket as well. Some patients like to use a soft headband underneath the scalp cooling cap to cushion your forehead and ears.
• Some people choose to take a dose of paracetamol about 30 minutes before scalp cooling starts, to help reduce the headache effect that they may experience.
• Go to the bathroom before you get connected to the scalp cooing machine. Make sure to ask the nurse to show you how to disconnect and connect the cap from the tubing.

Caring for your hair in-between scalp cooling treatments

• Be gentle with your hair at all times and don’t wash your hair immediately after scalp cooling. Wait 24 – 48 hours (if you need to wash your hair immediately use cool water).
• Aim to wash your hair once a week with lukewarm water. Use gentle shampoo that is sulfate and paraben free, e.g.: Professional hair salon products, or baby hair products (please check prior to using).
• Don’t use a hair dryer or straightener. Avoid harsh chemicals that can lead to dry hair and breakage such as hair colouring.
• Limit brushing your hair and always use a wide tooth comb. If your hair becomes tangled, use your fingers to comb conditioner through your hair. With dry hair, it helps to hold the hair above the tangles, so you don’t pull on the hair roots.
• Use scrunchies instead of hair ties and as a bonus, treat yourself to a satin/silk pillowcase.