# Scalp cooling during chemotherapy: suitability, preparation and cooling times

Source: https://onco.cc/protocols/scalp-cooling-during-chemotherapy/  
OnCo record `scalp-cooling-during-chemotherapy` (Protocol). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

A cold cap worn before, during and after a chemotherapy drip can help some people keep much of their hair, especially with taxanes such as paclitaxel and docetaxel. It is not suitable for blood cancers or for people very sensitive to cold. For taxanes, trials show 20 minutes afterwards works as well as longer. It does not always work, and results depend on the chemotherapy.

## Summary

Machine scalp cooling (DigniCap, Paxman) is FDA-authorised to reduce the likelihood of chemotherapy-induced alopecia in women with breast cancer (the 2015 De Novo and 2017 510(k) decisions read); later extensions were not read. In the SCALP randomised trial (Paxman, 142 evaluable), 50.5 per cent of cooled women kept their hair against 0 per cent of controls. Contraindications in the DigniCap instructions are cold sensitivity, cold agglutinin disease, cryoglobulinaemia and cryofibrinogenaemia, and haematological malignancy treated with curative intent. A 2025 meta-analysis of 67 studies found scalp metastasis in 0.15 per cent; common effects were chills (42 per cent), cap heaviness (35 per cent) and headache (30 per cent), and 18 per cent stopped cooling.

There is no guideline-defined schedule. Pre-cooling of 30 minutes is the accepted standard. Post-infusion cooling time depends on the regimen: randomised trials found 20 minutes as effective as 45 minutes after docetaxel and after weekly paclitaxel (the 2022 authors call 20 minutes the new standard of care), while with FEC extending from 90 to 150 minutes did not significantly reduce head-cover use; the Dutch registry (4680 patients) found under 85 minutes as effective as longer for the taxane and anthracycline regimens studied. Wetting hair before cooling lowers scalp temperature but, in the Dutch registry of 1825 patients, added little and slightly raised discontinuation for intolerance. Results are poorer with anthracyclines and with taxane plus anthracycline regimens.

## Fields

- Kind: Protocol
- Last checked: 2026-11-11
- Also known as: cold cap; cool cap; scalp hypothermia; Paxman; DigniCap; post-infusion cooling time; PICT; preventing hair loss during chemotherapy
- Tags: protocol; alopecia; scalp-cooling; supportive-care

## Connected records

- cancers: [Breast cancer (all types)](https://onco.cc/cancers/breast-cancer/)
- fronts: [Supportive Care & Survivorship](https://onco.cc/fronts/supportive-care/)
- technologies: [Manual cold caps (Penguin and other frozen-gel caps)](https://onco.cc/technologies/manual-cold-caps/), [Scalp cooling (cold caps: DigniCap, Paxman)](https://onco.cc/technologies/scalp-cooling/), [Wigs, cranial prostheses and head coverings](https://onco.cc/technologies/wigs-cranial-prosthesis/)
- drugs: [Cyclophosphamide](https://onco.cc/drugs/cyclophosphamide/), [Docetaxel](https://onco.cc/drugs/docetaxel/), [Doxorubicin](https://onco.cc/drugs/doxorubicin/), [Epirubicin](https://onco.cc/drugs/epirubicin/), [Paclitaxel / nab-paclitaxel](https://onco.cc/drugs/paclitaxel/)
- companies: [Dignitana](https://onco.cc/companies/dignitana/), [Paxman](https://onco.cc/companies/paxman/)
- terms: [Anthracyclines (doxorubicin, epirubicin)](https://onco.cc/terms/anthracycline/), [Hair loss and scalp cooling with breast cancer chemotherapy](https://onco.cc/terms/hair-loss-and-scalp-cooling-breast/)
- ideas: [Finish scalp cooling away from the infusion chair](https://onco.cc/ideas/idea-mach-cooling-off-the-chair/), [Fund scalp cooling and hair-preserving measures for every alopecia-inducing regimen](https://onco.cc/ideas/idea-moon-hair-preservation-for-all/), [Twenty minutes of scalp cooling after a taxane drip, rather than ninety](https://onco.cc/ideas/idea-upgrade-twenty-minute-post-infusion-scalp-cooling-after-taxanes/)

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