For Oceanside resident Sharesse Daniels, losing her hair during chemotherapy was something she knew was coming. But nothing prepared her for how it would feel.
“I was looking at myself in the mirror, and my hair was just falling out,” Daniels said. “I started screaming and pulling it. I just started pulling it at that point. And my family had to rush in and calm me down.”
Daniels was 25 when she was diagnosed with Hodgkin lymphoma, a cancer of the lymphatic system. She later battled breast cancer and is now facing another cancer diagnosis.
With each round of chemotherapy, Daniels said she found better ways to cope with losing her hair.
“I am now a wig connoisseur. I know about wigs, I know how to wear them, style them,” she said.
Still, she wishes she had another option.
“It would have meant the world to me,” she said.
That option is scalp cooling.
Sharp HealthCare Oncologist Mariela Macias uses scalp cooling as part of her patients’ treatment.
“Scalp cooling is a mechanism that uses a portable refrigeration unit and a very well-fitted cap for the patient,” she said. “It’s adjusted, made for them before they start ... and is used to prevent chemotherapy-induced alopecia, or hair loss,” Macias said.
It doesn't work for everyone, but can significantly reduce hair loss for many patients, up to 50% to 75%, Macias said.
“The candidates are for solid tumors, tumors that are similar to breast, ovarian, colon treatments,” she said.
Some patients may not be candidates, she said, including those with conditions where exposure to cold could be painful.
The technology can also be expensive. Macias said some of her patients have wanted scalp cooling but could not afford the additional cost.
“Oh, it was so often and sometimes it was so devastating,” she said. “Cancer can cause also financial burden, so spending those $2,500 or $5,000 extra is sometimes not part of the plan.”
Macias said cost has sometimes affected patients’ treatment decisions.
“I had a few people … who refused chemotherapy when this was an out of pocket expense, which could be detrimental to their health.”
Now, California is expanding coverage.
Gov. Gavin Newsom signed AB 1682 on Sept. 27.
Starting Jan. 1, 2027, the law requires large-group health plans and Medi-Cal to cover FDA-cleared scalp cooling for eligible chemotherapy patients. It also adds scalp cooling to the Medi-Cal benefit, subject to federal approval and medical necessity.
An analysis by the California Health Benefits Review Program identified three FDA-cleared automated systems: Paxman, DigniCap and Amma. Manual cold caps that are stored in a freezer or with dry ice are not included.
Its analysis also found evidence of disparities in access to scalp cooling, including cost barriers.
For Macias, expanding coverage means more patients may have the option.
“Making it available to people that would not otherwise have access to it is incredible.” she said. “Especially, I think making it available to the Medi-Cal population.”
For Daniels, the technology came too late. Having that option years ago, she said, could have made a painful part of treatment a little easier.
“To lose your hair, it was devastating,” she said. “I wish I had something like that back then.”
