Icing During Chemo: Does It Really Help with Neuropathy and Hair Loss?

If you’re going through chemotherapy for bowel cancer, especially as a younger adult, there’s a good chance you’ve come across the idea of icing hands, feet or your scalp during treatment. The goal? To reduce the risk of peripheral neuropathy or hair loss, two of the more frustrating and sometimes long-lasting side effects of chemo.

But how does icing actually work? And is it worth trying? Let’s dive into what the research says, how Australians can access these strategies, and what you might want to weigh up before giving cold therapy a go.

What Is Cold Therapy During Chemotherapy?

Cold therapy (also known as cryotherapy) involves exposing parts of the body to cold temperatures during chemotherapy infusion. This is typically done in two ways:

• Scalp cooling: Using a cold cap or scalp cooling system to reduce blood flow to hair follicles in the scalp.
• Limb cooling: Applying ice packs or frozen gloves/socks to the hands and feet to limit the drug’s exposure in those areas.

The idea behind both methods is similar, reduce blood flow to certain areas so that less chemotherapy reaches them, which may lessen side effects like nerve damage or hair loss.

Can Icing Help Prevent Peripheral Neuropathy?

Peripheral neuropathy is a common side effect of several chemotherapy drugs used to treat bowel cancer, particularly oxaliplatin. It can cause tingling, numbness, pain, and temperature sensitivity, especially in the hands and feet.

What the research says

• Some small studies suggest that cryotherapy with frozen gloves and socks during oxaliplatin infusion can significantly reduce the incidence and severity of neuropathy.
• A 2020 Japanese trial found that using frozen gloves and socks reduced both short-term and long-term neuropathy symptoms in patients receiving oxaliplatin.
• However, results aren’t consistent across all research, and some studies have shown minimal impact.

How it works

By cooling the limbs, vasoconstriction occurs, blood vessels narrow, slowing down the delivery of chemotherapy drugs to nerve endings. The idea is to protect nerves from damage by limiting drug exposure.

Things to consider

• Timing matters: Icing is usually started 15 minutes before chemo begins and continues throughout the infusion and for 15–30 minutes after.
• Not suitable for everyone: People with Raynaud’s disease or poor circulation may not tolerate cold therapy well.
• Discomfort: Some find icing physically painful or hard to tolerate for long periods.
• More research is needed: While early findings are encouraging, cryotherapy hasn’t yet become standard practice in Australia for neuropathy prevention.

What About Using Cold Caps to Prevent Hair Loss?

Hair loss (alopecia) isn’t a major concern for all bowel cancer patients, as many chemotherapy regimens used for colorectal cancers, like FOLFOX or CAPOX, don’t typically cause full hair loss. However, some people still experience hair thinning, and cold caps are often discussed in broader cancer communities, especially in breast cancer.

How scalp cooling works

Scalp cooling caps work on the same principle, constricting blood flow to reduce chemo exposure to hair follicles. They’re worn tightly on the head before, during, and after chemo.

What we know

• Scalp cooling has been shown to be effective in reducing hair loss in chemotherapy regimens that cause alopecia, but it’s less effective when used with drugs like oxaliplatin that are not primarily associated with complete hair loss.
• A 2017 randomised trial published in JAMA found that women with breast cancer using scalp cooling retained more hair than those who did not.
• For bowel cancer patients on oxaliplatin-based treatments, scalp cooling may offer minimal visible benefit but those receiving different regimens may still find it helpful.

Where to access cold caps in Australia

• Cold cap machines are available at some private oncology clinics and hospitals across Australia.
• Paxman and DigniCap systems are the most commonly used in Australia.
• Not all facilities offer this, it’s worth asking your treatment centre if scalp cooling is available or whether you’d need to bring your own portable system.

Are There Any Risks or Downsides?

While icing during chemo is generally considered safe, it’s not without potential drawbacks.

Possible downsides of cryotherapy:

• Cold intolerance or pain: Some people find the process very uncomfortable and difficult to maintain for long infusion times.
• Frostbite risk: If not done carefully or monitored, especially with DIY methods at home, there’s a small risk of skin damage.
• Limited evidence for bowel cancer: While research is promising, there isn’t yet a national guideline recommending it for bowel cancer neuropathy prevention in Australia.
• Cost: Scalp cooling, in particular, may not be covered by Medicare or private insurance, and out-of-pocket costs can be high.

Tips If You’re Thinking About Trying Icing

Speak to your oncologist or chemo nurse

• Discuss whether your chemo drugs are likely to cause neuropathy or hair loss.
• Ask if cold therapy is offered at your hospital or if it’s safe to try yourself.

If doing limb icing at home

• Use soft gel ice packs or frozen gloves/socks.
• Rotate packs to keep the cold consistent during the session.
• Wrap ice packs in a thin towel to avoid direct skin contact and frostbite.
• Start icing 15 minutes before chemo starts, continue throughout, and stop 15–30 minutes after infusion ends.

If using a scalp cooling cap

• Ask your centre if cold cap systems are available.
• You may need to book your use of the machine or bring your own device.
• Prepare for longer infusion times, as scalp cooling can extend your day in the chemo chair.
• Be aware of associated costs, especially in private clinics.

Where to Learn More in Australia

• Bowel Cancer Australia – Trusted, patient-focused information and support, including a Helpline and peer support groups.
• Cancer Council Australia – Offers resources on managing side effects and local support services.
• Paxman Scalp Cooling – Information on scalp cooling caps and where to access them across Australia.
• Cold Cap Australia Facebook Group – A private peer-to-peer support community for those exploring or using cold caps.

Final Thoughts

Icing during chemotherapy isn’t a guaranteed way to prevent neuropathy or hair loss but for some bowel cancer patients, especially those on oxaliplatin, it might offer a degree of protection, or at least peace of mind. The key is to weigh up the possible benefits, risks, and effort involved.

While scalp cooling may not be necessary for many undergoing chemo for early-onset bowel cancer, limb cryotherapy has growing support, especially from smaller studies. If you’re considering it, having an open conversation with your medical team is the best first step.

Even if the evidence isn’t watertight yet, many patients say it’s worth trying, particularly if neuropathy is something you’re keen to avoid.