oncolex logo
Utskriftsdato (18.10.2017)

Scalp Cooling Treatment


Medical editor Gunnar B. Kristensen MD
Gynecologist
Oslo University Hospital
Norway

Anne Kathrine Aares Tronstad
Oncology Nurse
Oslo University Hospital
Norway

General

Scalp cooling has long been a well-known technique to prevent hair loss. In 1996 in Great Britain, a machine was developed for the technique, which has a thermostat cooling system of glycol and water. The fluid circulates in a silicon cap placed on the head of the patient. Today there about 450 cooling cap machines in use, most of which are in Europe. Of these, about 60 are in the Nordic countries, 30-35 of which are in Norway. At Oslo University Hospital, 2-3 patients receive this treatment daily. A cooling machine reduces the temperature in the scalp to about  10 ºC using a cooling cap and is effective at preventing hair loss caused by chemotherapy of moderate intensity.

The mechanism of action appears to be partly vasoconstriction, but more importantly, temperature-dependent reduction of cellular uptake of chemotherapy drugs. Successful results are achieved with taxane.

The effect of cooling cap treatment is individual, but experience shows that most patients using this technique are able to avoid using a wig.

In order for the patient to gain the optimal effect of cooling treatment, it must be applied from the first to the last treatment. Since not all patients receive chemotherapy at Oslo University Hospital, it must be determined whether the patient can receive scalp cooling treatment during all chemotherapy courses before starting. Some patients apply for treatment at a hospital where they know scalp cooling treatment is available.

Indications

To what degree scalp cooling affects the temperature conditions in the bone marrow of the cranium does not appear to be sufficiently documented. In the literature, concern has been expressed that cooling may conserve micrometastases in the scalp; however, documentation of this is scarce. Due to this lack of documentation, Oslo University Hospital has decided that scalp cooling treatment is not recommended during chemotherapy with curative intention for cancers where micrometastases in the scalp or bone marrow is a problem (breast cancer, malignant lymphoma, leukemia). 

For palliative chemotherapy however, it appears the method is acceptable as well as for chemotherapy with curative intention for cancer where metastasis to the skin, subcutis or bone marrow is uncommon.

For gynecological cancers, bone metastases are very rare. Scalp cooling is therefore not contraindicated during chemotherapy for such cancers. For many women, hair loss is significant for their self image. We recommend offering gynecological cancer patients the option of scalp cooling to prevent hair loss during chemotherapy. 

Goal

  • Prevent chemotherapy-induced hair loss (alopecia).

 


Equipment

  • Scalp cooling machine
  • Scalp cap with coupling  
  • Paper cap
  • 5 unsterile compresses 10 x 10 cm
  • Towel
  • Chair or bed for the patient
  • Blanket or warm water bottle   

Preparation

Preparation for use of scalp cooling machine

Before the machine is turned on

  • Check that the plug is in the outlet and is connected.
  • Check the level of the fluid in the window on the back of the apparatus and fill if necessary.
  • Check that the tubes to the fluid are not twisted or broken.
  • Check that there is no visible leakage of cooling fluid.

When the machine is turned on

  • When the power is on, the light should be green.
  • Make sure that both tubes for the cooling fluid are connected to the recirculation ports.
  • Press PUMP ”on” when the left display shows a temperature of -4 °C to -5 °C.
  • Listen for the motor.
  • The temperature of the cooling fluid is shown on a designated thermometer.
  • When the right display shows HI and a sound alarm starts, push the MUTE button on the control panel. When only one arm is used, the available arm is connected to the machine.

After 15 minutes

  • The display will show a slow decreasing temperature.
  • When the left display shows -4 °C to -5 °C, and the right display shows lower than 5 °C, the system is ready for use. This may take from 1 hour to 90 minutes after PUMP "on" is pressed, depending on the temperature of the room.

Preparation of the patient

Choose the correct size of the cap (small, medium, large).

Recommended cooling times for common chemotherapy drugs
  Before After
FEC/EC
30 minutes 1–1 ½ hour
Paclitaxel weekly 90 mg/m2 30 minutes 1 hour
Paclitaxel triweekly 175 mg/m2 30–45 minutes 1 ½ hour

Implementation

  • The patient sits in a chair or lies in a bed 45 minutes before the chemotherapy infusion starts. 
  • The strap from the cap should be fastened under the chin - the patient may do this to make sure it is comfortably tight.
  • Make sure the cap fit snugly to the scalp, especially on the upper part of the head.
  • Tighten the straps on the cap - this is critical for maximal effect.
  • Place compresses between the chin and chin strap.
  • Protect the patient's ears and forehead with compresses if the patient feels that they become too cold. A towel can be placed around the neck.
  • Turn off the pump on the machine and connect the cap. 
  • Turn on the pump again and check that the cooling fluid is circulating and the cap becomes cold.
  • Ensure the patient is as comfortable as possible.
  • The patient usually experiences the first 10-15 minutes as the coldest but adapts to the temperature.
  • The patient sits/lies with the cap on for 30-45 minutes before the chemotherapy infusion starts depending on the type of chemotherapy. 
  • The chemotherapy infusion is connected to the patient.
  • The patient sits with the cap on during the entire infusion. If the patient needs to visit the toilet, the pump is turned off and the cap is disconnected. The patient must keep the cap on while using the toilet.
  • The patient sits with the cap for 1-2 hours after the infusion is completed depending on the type of chemotherapy. 
  • When the treatment is finished, the pump is turned off.
  • Remove the cap, compresses, and paper cap.
  • The machine is turned off and the cap is disconnected from the machine.
  • The cap should be washed in warm soap water and dried.

Follow-up

Recommended hair care for optimal results  

Certain chemotherapy drugs and dosages cause hair loss after treatment is finished. Losing hair is a very sensitive issue for most, even if a wig is an option. 

Scalp cooling treatment can contribute to preventing or reducing hair loss to avoid use of a wig.

Experience with scalp cooling treatment shows that 70-90% of patients do not need to use a wig, provided that recommended cooling times both before and after the infusion are followed (see preparation).

The result can be maximized by following these recommendations:

  • Use a neutral pH shampoo and conditioner.
  • Do not wash your hair less than 24 hours before treatment.
  • Limit hair washing and always use a conditioner.
  • Wash your hair in cool water with light finger motions.
  • Allow your hair to dry naturally without rubbing with a towel and do not use a hair dryer.
  • Use a soft, satin-like pillowcase for sleeping.
  • Use a wide-toothed comb instead of a brush.
  • Allow your hair to hang naturally instead of pulling it up/back.
  • Do not use hairspray or other products.
  • If you wish to color your hair, environmentally friendly products should be used.
  • Show this information when you visit the hair dresser.
  • Follow these recommendations for 6-8 weeks after the last treatment.  

For successful results, do not use harsh methods which will weaken your hair.

If you lose hair despite treatment and optimal care, continued cooling can further hasten growth.