Hair Braid
02 December 2016

Coping With Hair Loss During Chemo

Hair plays a surprisingly important role in our sense of identity, a role many people don’t fully understand until they begin to experience hair loss. Many cancer patients, who often lose their hair due to treatment, are surprised to learn how emotionally devastating chemo-related hair loss can be.

How To Deal With Chemo Hair Loss

Whether or not we should, most cancer patients fear the prospect of hair loss. In this context, fear should be turned into action. Know what to expect from the outset. If you haven’t yet discussed the side effects of your chemo regimen with your oncologist, make it a priority. Ask about the chances of hair loss and, if your treatments have been associated with the symptom, find out when it usually begins. Although your experience may be different from the experiences of past patients, you probably don’t have to be blind-sided by hair loss. Managing expectations, both our own and those of our loved ones, is important.

Woman With Braided Hair

Even with an accurate understanding of what could happen, watching your hair fall out in clumps can be distressing. That’s why many patients find it helpful to get a short hair cut before treatment begins, so the transition to a bald head isn’t so severe. Some people just shave their heads completely in advance. In one sense, cutting hair loss off before it happens is a way of taking control over a situation that often feels uncontrollable.

After hair loss begins, many women choose to wear wigs or head scarves, both as a way of camouflaging their condition and recreating their prior appearance. If you plan on wearing a wig, try to get fitted for one before your hair loss begins. That way a stylist can imitate your hair as closely as possible, if that’s what you’re going for.

How To Cope When Other People Try To Cope

We don’t live in a vacuum. Talking to other people about hair loss is one of the hardest things about going through chemo. Of course, you don’t have to talk about it at all if you don’t want to. If you’re uncomfortable talking about your condition, set firm boundaries and take control of social situations that can become awkward. There can be also be a sense of empowerment in openly acknowledging your hair loss, rather than leaving an elephant in the room.

Hair Loss As Strength

Our culture places a lot of significance on hair, especially for women, who are so often taught to believe that their self-worth should be based on physical attractiveness. The first point to note is that there’s no good reason why a person without hair can’t be just as beautiful as someone with hair.

Some people even find losing their hair to be an empowering experience. Ask Lauren Erdman, who was diagnosed with non-Hodgkin’s lymphoma at 19. In an interview with the Cancer Treatment Centers of America, Erdman described her own hair loss as a newfound source of strength. While she was, at first, shocked by the process of losing her hair, Erdman came to see her bald head as a symbol of something powerful. She was fighting her cancer, not succumbing to a disease. Most importantly, hair loss was an opportunity for Erdman to become “truly comfortable in her skin.” She may have looked different in the mirror, but Erdman was able to affirm the fact that she, as an individual, was not different.

There’s no right way to deal with cancer. Hair loss is a big deal and, no matter how you choose to cope with that loss, acknowledge your feelings. If the process is traumatic, recognize the fact that you have lost something very real. That doesn’t mean lean into the trauma, but just know that people who say things like, “it’s just hair,” don’t understand what you’re going through.

Can Hair Loss Be Prevented?

There’s no proven way to prevent hair loss during chemotherapy, although a method known as scalp pooling has shown some promising results. To reduce the risk of hair loss, medical professionals suggest trying a proactive approach during treatment. While there’s little study data to substantiate the effectiveness of these measures, many patients report seeing good results after treating their hair and scalp very gently:

  • using mild (often baby formula) hair-care products
  • avoiding artificial hair colors and damaging curlers
  • switching to a soft-bristle brush

Oddly enough, hypnosis has been suggested as a potential cure for chemotherapy-related hair loss. As we’ve shown elsewhere, the idea that relaxation exercises or guided visualizations could hold alopecia at bay is likely wishful thinking, not reality.

Combination Therapies & Hair Loss

Hair loss is usually more common during combination therapy, when two or more chemotherapy drugs are used at the same time.

One surprising example of this fact is cisplatin, a cornerstone treatment for many cancers. Most patients who receive only cisplatin will not experience hair loss. In clinical trials, fewer than 10% of patients administered cisplatin as a monotherapy lost their hair. In practice, however, the drug is normally used as just one element in a combination therapy. Outside of clinical trial settings, most patients who receive cisplatin will experience hair loss, either because their other chemo agents cause the symptom or because cisplatin and another drug interact to increase the risk for hair loss.

Most cancer patients experience only temporary hair loss. In fact, only two chemo agents, Taxotere and busulfan, have been linked to a risk of permanent alopecia. That’s the good news; it’s highly likely that your hair will grow back after treatment, although it may be different than it was before. Despite the likelihood of regrowth, losing your hair in the first place can be extremely disconcerting.

Do All Chemo Patients Lose Hair?

Most people, at least those who have not been initiated into the world of oncology, believe that all chemotherapy drugs lead to hair loss. Being bald, after all, may be the only universally-recognized indicator that someone has cancer. Think of a cancer patient and most laypeople will envision someone without hair, and this is one reason why hair loss can be so painful for actual cancer patients. It’s like a sign that you have cancer, one that’s difficult to hide.

In reality, most chemotherapy drugs, even those that almost always lead to hair loss, won’t cause the symptom in every patient. It’s a well-worn adage, but every patient reacts differently to medications, no matter how toxic they have proven in the past. Moreover, some chemo drugs don’t cause hair loss at all, or only lead to alopecia in a small minority of patients. Capecitabine, for example, a drug used to treat breast, esophageal and colorectal cancers, has been shown to cause hair loss in only around 6% of people.

To learn more about the hair loss differences between chemo drugs, click here.

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