FAQs

Q: Why cold caps?

A: Studies have shown that wearing a cold cap slows down the metabolic rate at which hair cells absorb nutrients or anything else in the blood like chemotherapy drugs. As a result when the chemo in the blood goes into the hair bulbs the absorption rate is minimal, and most hair can withstand this level of attack (some thinning may occur). One specific type of cold cap has been in use overseas for 15 years with great success.

Q: Why is the freezer important?

A: The recommended temperatures for cold cap therapy may vary by cap manufacturer, but are generally substantially below 0° F. Standard freezers do not get cold enough. The caps can be cooled with dry ice, but dry ice is difficult to handle and uniform temperature control is problematic. A biomedical freezer keeps all caps ready at the correct temperature, continuously. Typically, 13-17 caps are used during a single chemotherapy session, so this is most valuable.

Q: Are the cold caps uncomfortable?

A: For about the first five minutes after each cap is put on, the sensation is quite cold. Warm blankets are helpful, and a shoulder massage seems to help as well. The discomfort dissipates after that, and the remaining 25 minutes of wear are comfortable to the point that one can hold a normal conversation or even play cards to pass the time.

Of note, even if a patient had chemotherapy without cold cap therapy, his/her body would feel cold because the saline being infused into the blood circulatory system is at ambient (room) temperature, not body temperature. This is why chemo clinics often supply blankets and patients are usually advised to wear sweaters.

Q: How difficult is it to learn to use the caps?

A: Practice makes perfect. We recommend a couple of dry runs with non-frozen caps at first. A minimum of one person assisting the patient is essential, and more than one is helpful but not critical. The patient's helper(s) need to keep track of time, keep the patient drinking water throughout the process, check the temperature of the new caps (especially if on dry ice and not in a freezer), swap out the old and new caps and straps, and keep the patient warm during the first five minutes of each cap application. As each complete cap change has to occur in less than two minutes, and the actual scalp exposure time between caps must be only a few seconds, everyone needs to know his/her job. Again, practice really helps.

Q: Are cold caps just for women?

A: Not at all. Cold cap therapy can be used by men, women and children.

Q: What is the response from actual patients who have used cold cap therapy?

A: Research available for one brand of cold caps has shown that over 95% of all patients who have used the caps would use them again. To view testimonials from some of these patients, please visit the following links:

Medical Specialties of California (MSC)
Eileen Bradley
Eve Grossman

Q: I’m about to undergo chemotherapy and my doctor hasn't mentioned cold cap therapy. Is it not widely available?

A: Because cold caps are still in clinical trials in the U.S., awareness is minimal, and hospitals do not have them. However, with the approval of the patient's physician, individuals can rent their own caps from the manufacturers. The Rapunzel Project is trying to facilitate the use of cold caps by helping hospitals purchase the freezers that make cold cap therapy more manageable for more patients.

Q: What does cold cap therapy cost?

A: Costs will vary depending on the cap manufacturer. Other factors affecting costs include the number of chemo sessions, or the number of months the caps will be in use.

Q: Is cold cap therapy covered by insurance?

A: Check with your individual carrier. Note that even if cold cap therapy is not covered at this time, plans and benefits evolve. As the cost of cold caps is likely to be comparable to the cost of a medically prescribed wig, insurance acceptance of cold caps is likely to grow. In fact either cold caps or medically prescribed wigs should be treated as a cranial hair prosthesis. Some plans do cover this, and this is how your physician's prescription should be written.

We have recently learned of a New York State employee whose insurance (through the state) did pay for about 85% of her cold cap rental expenses. Here's her story:

My oncologist's prescription stated that it was for a "Full Hair Prosthesis" for chemo induced alopecia, dx. code 179.9. When I telephoned my insurance company, they told me they would cover up to $1,500 for the cost of a wig.

After I completed chemo, I submitted the prescription, an invoice from MSC-Worldwide, and copies of my credit card statements showing the monthly fees I paid. (I submitted nothing about the deposit.) The insurance company first rejected my submission with no explanation code. I followed up by telephone and was told they rejected it because it was for a rental, not a purchase. I argued that no one told me about a rental exclusion etc. and they very nicely said that they would resubmit the claim, which much to my surprise, they then paid!

For further discussion of insurance coverage for cranial prostheses for chemo-induced hair loss, please read here.