What are the indications for coldcap therapy in cancer treatment?

October 8, 2025 •

2 min read

Studies show that scalp cooling can help over 50% of patients retain most of their hair during certain chemotherapy treatments. This article explores what are the indications for coldcap therapy, who is eligible, and how it works.

Quick Summary

Cold cap therapy is indicated for patients with solid tumors to reduce hair loss from certain types of chemotherapy. Eligibility depends on cancer type, chemo regimen, and overall health.

Key Points

Primary Indication: Cold cap therapy is FDA-cleared for adult patients with solid tumors to reduce hair loss from alopecia-inducing chemotherapy.
Mechanism of Action: It works by cooling the scalp, which constricts blood vessels and reduces the amount of chemotherapy drug reaching the hair follicles.
Eligible Cancers: It is used for various solid tumors, including breast, prostate, ovarian, uterine, and certain lung cancers.
Contraindications: The therapy is not for patients with blood cancers (leukemia, lymphoma), head and neck cancers, scalp metastases, or certain cold-related medical conditions.
Effectiveness Varies: Success rates depend heavily on the type and dose of chemotherapy, with taxane-based drugs showing higher efficacy than anthracyclines.
Two System Types: Options include manual caps that require changing and automated systems that circulate a coolant continuously.
Consultation is Key: Patients must discuss with their oncologist to determine if scalp cooling is an appropriate option for their specific treatment plan.

Understanding Cold Cap Therapy and Its Mechanism

Cold cap therapy, also known as scalp cooling, is a treatment designed to reduce hair loss (alopecia) for patients undergoing chemotherapy. Chemotherapy drugs target rapidly dividing cells, including those in hair follicles, leading to hair loss.

Scalp cooling works by:

Vasoconstriction: Lowering scalp temperature constricts blood vessels, reducing blood flow and the amount of chemotherapy reaching hair follicles.
Reduced Metabolic Activity: The cold also slows cell division in hair follicles, making them less susceptible to chemotherapy.

The therapy involves wearing a cooled cap before, during, and after chemotherapy infusions to maintain a consistent low scalp temperature.

Primary Indications for Cold Cap Therapy

The FDA has cleared scalp cooling systems for adult cancer patients with solid tumors receiving chemotherapy that causes hair loss. Initially for breast cancer, this expanded in 2017 to include other solid tumors like ovarian, prostate, colorectal, uterine, and certain lung cancers. Since 2019, scalp cooling is included in NCCN guidelines for supportive care in breast and ovarian cancer.

Patient Eligibility and Contraindications

Eligibility for cold cap therapy is not universal and requires discussion with an oncologist.

Who is a good candidate?

Adult patients with a solid tumor receiving alopecia-inducing chemotherapy are typically good candidates. The therapy should start with the first session.

Contraindications: Who Should Not Use Cold Caps?

Scalp cooling is not recommended for:

Pediatric patients (under 18).
Patients with blood cancers (leukemia, lymphoma).
Those with head and neck cancers, skin cancers, CNS malignancies, or certain lung cancers.
Individuals with known or potential scalp metastasis.
Patients undergoing bone marrow ablation chemotherapy or skull irradiation.
Those with cold sensitivity conditions like cryoglobulinemia or cold urticaria.
Patients with severe liver or kidney disease may also not be eligible.

Effectiveness and Influencing Factors

Effectiveness varies, with success rates (retaining ≥50% hair) from 40% to over 90% in some studies. Key factors influencing success include:

Chemotherapy Regimen: Taxane-based regimens (up to 96% success) are generally more effective than anthracycline-based regimens (around 71% success).
Cap Fit: A snug fit is essential.
Patient Adherence: Following cooling protocols is crucial.

Comparison of Scalp Cooling Systems


Feature	Manual Cold Caps	Automated Systems
Cooling Method	Gel caps pre-chilled with dry ice, requiring changes.	Cap connected to a refrigeration unit for constant cooling.
Temperature	Can reach -28° to -34° C.	Maintains around 3° C.
Convenience	Requires assistance for cap changes.	Less labor-intensive, computer-controlled.
Cost	Renting (around $1,500-$3,000) plus dry ice.	Cap kit purchase and per-treatment fee (around $2,200 for 12 treatments).

Conclusion

Cold cap therapy is a supportive care option for adult patients with solid tumors receiving chemotherapy. It reduces hair loss by constricting scalp blood vessels and slowing follicular metabolism. Success depends on the cancer type, chemotherapy, and adherence to protocol. Patients should consult their oncologist to determine suitability.

For more information, the American Cancer Society is a helpful resource.

Frequently Asked Questions

Adult patients with solid tumors (like breast, prostate, or ovarian cancer) undergoing chemotherapy known to cause hair loss are generally eligible. Eligibility depends on cancer type, chemo regimen, and other medical conditions, and must be confirmed by an oncologist.

No, its effectiveness varies significantly based on the chemotherapy drugs used. It tends to be more successful with taxane-based regimens (like Paclitaxel) and less effective with anthracycline-based regimens (like Doxorubicin).

Some patients experience discomfort, cold-induced headaches, chills, or scalp pain, particularly during the first 10-15 minutes of treatment. However, most people find it tolerable, and few discontinue therapy due to discomfort.

The most common side effects are temporary, such as headaches, dizziness, and chills. There has been a theoretical concern about scalp metastases, but studies have not found a significant difference in risk between patients who use scalp cooling and those who do not.

Scalp cooling is contraindicated for pediatric patients, those with blood cancers (leukemia, lymphoma), certain head and neck or skin cancers, and individuals with cold sensitivity disorders like cryoglobulinemia or cold urticaria.

The cost varies by system. Manual caps can cost $1,500-$3,000 for a treatment course plus the cost of dry ice. Automated systems might involve a one-time cap kit purchase and a per-treatment fee, totaling around $2,200 for 12 treatments. Some insurance plans may offer reimbursement.

For the therapy to be effective, it must be started with your very first chemotherapy infusion and used for every subsequent treatment session.