American systematic review and meta-analysis shows no statistical difference in the incidence of scalp metastases in scalp cooled and non-cooled patients. This conclusion shows that previous concerns that have limited the use of scalp cooling were unfounded.
0.61% of 1959 patient who scalp cooled showed incidence of scalp metastases over a mean time frame of 43.1 months. 0.41% of 1238 patients that didn’t scalp cooled group showed signs of scalp metastases over a mean time frame of 84.7 months.
Scalp metastases occur rarely in breast cancer (with metastases more commonly occurring in other areas of the skin including chest wall), and scalp metastases seem to accompany and usually occur following the diagnosis of widespread metastatic disease.
Retrospective studies use pre-recorded data, therefore most studies used did not specifically asses scalp metastasis as a primary end point.
Studying of scalp metastases in scalp cooled patients continues to assure data is relevant over a longer average time frame.
Scalp cooling has no impact on survival rates when used with chemotherapy in a non-metastatic setting 
A Canadian, retrospective, multicentre cohort study based on 533 women who used scalp cooling and 817 women who did not.
The following variables were considered – age at diagnosis, stage of cancer, presence of lymphovascular invasion grade, type of chemotherapy (taxane or anthracycline), oestrogen receptor status, timing of chemotherapy (adjuvant or neo adjuvant).
Many thousands of men and women throughout the world have retained their hair using the Paxman Scalp Cooling System while receiving chemotherapy treatment.
The Paxman Scalp Cooler is indicated to reduce the likelihood of chemotherapy-induced alopecia (CIA) in cancer patients with solid tumors.
The Paxman Scalp Cooling System is intended for use by appropriately qualified healthcare professionals who have been trained in correct operation of the device by a Paxman representative.
You should be aware of the following:
Scalp cooling is contraindicated in pediatric patients. Scalp cooling is contraindicated in patients with:
Clinical studies have successfully demonstrated the effectiveness of the Paxman Scalp Cooling System in the prevention of chemotherapy-induced alopecia, or hair loss, with widely used chemotherapy dosages and regimens for solid tumor cancers. Hair retention rates are variable, however, since successful scalp cooling depends on many factors such as the chemotherapy regimen and dose, duration of drug infusion, metabolism of the chemotherapy drug, and concomitant comorbidities or other conditions. Age, hair type, hair condition, and general health can also affect the results of the Paxman Scalp Cooling System.
It cannot be guaranteed that scalp cooling will prevent all patients undergoing chemotherapy from losing any or all of their hair. The success rates of scalp cooling in reducing chemotherapy-induced alopecia, or hair loss, vary from patient to patient and depend on the chemotherapy regimen administered.
Research has shown that scalp cooling is very effective across a wide range of chemotherapy regimens. You may experience some hair loss and overall thinning of the hair while using scalp cooling, and the normal shedding cycle of the hair will continue. We encourage you to continue scalp cooling even if you experience some hair loss, Many people report hair growth during their chemotherapy treatment while using scalp cooling, as new hair growth is also protected from the chemotherapy drugs.
Based on recent research, it is advised not to buy a wig during scalp cooling. The study suggests that you should wait until a wig becomes necessary. This study was authored by Dr van den Hurk and others.
Your healthcare professionals and medical team will let you know if scalp cooling is likely to be successful with your chemotherapy treatment.
Hair loss is very common during chemotherapy for breast cancer as well as other cancers, though some drugs and methods of administration are more likely than others to disrupt hair follicles.
Chemotherapy-induced hair loss is a common and distressing side effect of cancer therapy and is one of the major unmet challenges in cancer management. Scalp cooling can prevent chemotherapy-induced hair loss in some cancer patients with solid tumors receiving certain chemotherapy regimens. Recent evidence indicates that this technique does not increase the risk of scalp metastasis. A reduction in post-chemotherapy infusion duration of scalp cooling and the advancement in cool cap technology may assist clinicians in promoting scalp cooling to cancer patients / to improve the patient experience of chemotherapy-induced hair loss.
Alopecia is a common side effect of chemotherapies used in the treatment of cancer. The effects of alopecia on quality of life (QOL) on various aspects of QOL in cancer patients includes anxiety and distress, body image, sexuality, self-esteem, social functioning, global QOL and return to work outcomes.
Hair loss consistently ranked amongst the most troublesome side effects, and is described as distressing, and may affect the body image. The presence and extent of negative effects on chemotherapy-induced alopecia on various aspects of QOL of patients who have had scalp cooling may be worse than those who did not have scalp cooling.
Whether a patient develops hair loss and the degree of hair loss depends on several factors including:
Chemotherapy-induced hair loss is almost always reversible.
Hair loss often begins around the time of the second chemotherapy infusion, though this varies widely. Some people do not lose all of their hair until they have nearly completed chemotherapy.
Data have shown that women who experience hair loss despite using scalp cooling might have worse quality of life than women who did not have scalp cooling. It is important to select those patients who would benefit most from scalp cooling.,
The following table identifies the chemotherapeutics cited as most likely to cause chemotherapy-induced alopecia. The risk of scalp cooling may outweigh the benefits in patients receiving chemotherapeutic agents with a high incidence of inducing alopecia.
Patients treated with certain chemotherapeutic agents, including AC, DAC and Irino mono, as well as patients with Asian or chemically-colored hair may be least likely to benefit from scalp cooling. The risk of scalp cooling may outweigh the benefits in patients that are least likely to benefit from scalp cooling.
Known side effects associated with scalp-cooling therapy include:
All of these side effects occur during the scalp cooling process. They are transient or temporary in duration, and are generally recognised as presenting a low risk of harm (although in some cases, patients have discontinued scalp cooling because of, these effects).
The majority of women using the Paxman Scalp Cooling System reported being able to tolerate a high level of cooling. They also reported a high level of comfort and acceptability. Few people discontinued scalp cooling because of side effects. Most patients were comfortable, reasonably comfortable, or very comfortable while wearing the device; many said they were reasonably comfortable. In the multicenter, randomized clinical trial that Paxman conducted in the United States for FDA clearance, only 6 participants of 142 patients discontinued scalp cooling because of intolerance. Data have shown that women who experience hair loss despite using scalp cooling might have worse quality of life than women who did not have scalp cooling. It is important to select those patients who would benefit most from scalp cooling.,
The only known potential long-term side effect of scalp cooling is also the most controversial one; this is that scalp cooling when used on women receiving chemotherapy for breast cancer could lead to an increased incidence of scalp metastases. (This is because the same mechanisms that restrict the effectiveness of the chemotherapeutic agent against hair roots or follicle cells in the scalp can also restrict the effectiveness of the chemotherapeutic agent against cancerous tissue in the scalp.)
The natural incidence of scalp metastases in patients with breast cancer is approximately 1 in 4000. This incidence seems to be about the same in patients who receive scalp cooling and those who don’t.
There is no clinical evidence that cooling the scalp during adjuvant and palliative chemotherapy treatment increases the risk of developing scalp metastases. The issue remains a theory or possibility, but it has not been proven.
The Paxman Scalp Cooling System is the leading product found to minimize the risk of hair loss during chemotherapy in women with breast cancer. Your healthcare professionals can advise you if scalp cooling is likely to be successful with your chemotherapy treatment, or whether any other treatments, or the use of a wig, scarf, or headcover, may be more appropriate.
1Rugo HS, Melin SA, Voigt J. Scalp cooling with adjuvant/neoadjuvant chemotherapy for breast cancer and the risk of scalp metastases: systematic review and meta-analysis. Breast Cancer Res Treat. 2017;163(2):199-205.
2Lemieux J, Provencher L, Perron L, Brisson J, Amireault C, Blanchette C, Maunsell E. No effect of scalp cooling on survival among women with breast cancer. Breast Cancer Res Treat. 2015 Jan;149(1):263-8. doi: 10.1007/s10549-014-3231-0. Epub 2014 Dec 16.
3van den Hurk CJ, van den Akker-van Marle ME, Breed WP, van de Poll-Franse LV, Nortier JW, Coebergh JW. Impact of scalp cooling on chemotherapy-induced alopecia, wig use and hair growth of patients with cancer. Eur J Oncol Nurs. 2013;17(5):536-540.
4Udrea, A. Scalp cooling system in preventing chemotherapy-induced alopecia: a pilot study on 108 patients – a Romanian oncology – day hospital experience. Medisprof Oncology. Psycho-Oncology 23 (Suppl. 3):169-254 (2014), P1-0062.
7Lemieux J, Amireault C, Provencher L, Maunsell E (2009) Incidence of scalp metastases in breast cancer: a retrospective cohort study in women who were offered scalp cooling. Breast Cancer Res Treat 118:547–552
8Parker R (1987) The effectiveness of scalp hypothermia in preventing cyclophosphamide-induced alopecia. Oncol Nurs Forum 14:49–53