Scalp Cooling for Chemo Hair Loss Strikes Out With Patients


Most women with breast cancer who received scalp cooling did not perceive benefits in preventing hair loss, overall quality of life, body image, and other outcomes compared with those who opted to forgo scalp cooling.


  • Although studies have demonstrated the effectiveness of scalp cooling to reduce hair loss during breast cancer chemotherapy, most were in the setting of single-agent regimens instead of much more commonly used combined chemotherapy, and few studies assessed patients’ subjective experience.

  • To get a real-world sense of the treatment, investigators compared outcomes in 75 women who opted to use the Orbis Paxman cooling cap during taxane/anthracycline-based chemotherapy sessions with 38 women with breast cancer patients who declined to use the cooling cap.

  • The women were surveyed for hair loss perception, functional health, and body image at baseline, mid-chemotherapy, and at their last chemotherapy cycle, as well as at 3 months and 6 to 9 months following chemotherapy. 

  • The women were treated at the Medical University of Innsbruck, Austria, for various stages of breast cancer; about half were premenopausal.


  • There was no significant difference between the scalp-cooling and control groups in patient-reported hair loss (P = .831), overall quality of life (P = .627), emotional functioning (P = .737), social functioning (P = .635), and body image (P = .463).

  • On average, women stayed on treatment with the cooling cap for about 40% of the duration of their chemotherapy.

  • Overall, 53 of 75 women (70.7%) stopped scalp cooling early, with most (73.9%) citing alopecia as the primary reason; only 30% completed treatment.


  • “The efficacy and tolerability of [scalp cooling] applied in a clinical routine setting…appeared to be limited,” the authors concluded. “The further determination and up-front definition of criteria prognostic for effectiveness of [scalp cooling] may be helpful to identify patient subgroups that may experience a treatment benefit.”


  • The work, led by Christine Brunner, Medical University of Innsbruck, Austria, was published July 17, 2023, in Breast Cancer: Targets and Therapy .


  • Shorter intervals between surveys might have given a more granular understanding of patients’ experiences with scalp cooling.

  • There were no biomarker assessments to help identify patients more likely to benefit.


  • The work was supported by the Medical University of Innsbruck.

  • Brunner disclosed a grant from Paxman UK, maker of the cooling cap used in the study. Another investigator disclosed personal fees from AstraZeneca, Daiichi Sankyo, Gilead, Lilly, Novartis, and Sirius.

M. Alexander Otto is a physician assistant with a master’s degree in medical science and a journalism degree from Newhouse. He is an award-winning medical journalist who worked for several major news outlets before joining Medscape. Alex is also an MIT Knight Science Journalism fellow. Email: [email protected].

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