"Will I lose my hair?" is often one of the first questions patients ask the doctor as they prepare for chemotherapy. "We may not want to admit it, but our hair is one of the things that defines us as who we are," says Laura Beemiller, an oncology social worker at the Zangmeister Cancer Center in Columbus, Ohio. "Patients feel like they're losing part of their identity, and it can be really hard to face such a big change in how they look and how others perceive them."

Different drugs cause different amounts of hair loss. All chemotherapy drugs have the potential to cause at least some hair loss. This happens because the drugs target fast-growing cells, so in addition to killing cancer cells, they can attack the cells in the hair follicles. But the potential for hair loss varies widely depending on the specific drug patients take, the dosage prescribed, and individual response. For example, certain chemo drugs are known to cause complete hair loss -- so complete that eyebrows, eyelashes, and body hair can be affected. But other drugs may not have such extreme effects, or may have them only in some people but not others.

Chemotherapy drugs known to cause the most extensive hair loss include Cytoxan, Taxol, Taxotere, and Adriamycin. There are also some chemo combination therapies that are known to cause extensive hair loss, says Beemiller. These include the regimens AC (Adriamycin and Cytoxan) and ACT (Adriamycin, Cytoxan, and Taxol).

Different patients lose their hair in different ways. The way hair loss manifests itself can vary widely, too: Some people may lose most or all of their hair, some may simply experience all-over thinning, and others may lose hair in patches. It's hard to predict what will happen. The best thing you can do is find out which particular chemo drug is being prescribed, so you can learn more about its potential effects -- regarding hair loss and other health issues as well.

Prepare for hair loss and plan to buy a wig.

Hair loss usually begins sometime between ten days and two weeks after the first chemo treatment. It may happen gradually or be dramatic, depending on the drug and dosage. Typically, patients will start to notice hair -- either clumps or individual strands -- on their pillow, hairbrush, and in the drain after showering. Often the peak point of hair loss is about two months into treatment. Patients will keep losing hair through the entire chemo process and for about a month after the last treatment. Then their hair will start to grow back.

Patients with long hair might want a haircut before treatment. It's commonly recommended that patients with long hair get a haircut before beginning chemo, so that when hair begins falling out it isn't so startling and disturbing. "If a woman has long hair, I'd suggest that she go to the hairdresser and get her hair cut shorter. If she has bought a wig, then she can have her wig styled at the same time," says Brooke Benack, also an oncology social worker at the Zangmeister Cancer Center. "Patients who get their hair cut feel much better because they're taking control. It also makes the hair loss less upsetting when it happens. Long hair coming out in clumps can be difficult to deal with, and seeing hair on a pillow or in the brush can be very emotional."

If the patient wants a wig, get it before chemo. Before a patient starts chemo, she's more likely to have a fair amount of energy, and you'll also have the advantage of being able to show the salesperson the color, texture, and shape of the person's hair, and the store can style a wig to match it as closely as possible.If patients wish to get a wig or hairpiece (and yes, many men do take this option!), you'll want to help make this purchase in advance.

Shopping for a wig may present a bit of "sticker shock," because good-quality wigs can cost upwards of $200. In many cases, insurance will cover all or part of this expense, but there may be restrictions on the coverage, such as limitations on what kind of wig a patient can purchase, and where. A "prescription" from the doctor may be required in order for the wig to be covered, and there may also be forms to fill out in advance to ensure reimbursement. Be aware, too, that in smaller towns or rural areas it may be hard to find a wig store.

If a patient can't afford a wig, an organization may help buy one. If the cost of a wig is prohibitive, there are organizations and programs that will cover all or part of the cost. However, applying to one of these programs also takes time and advance planning, which is why it's not a good idea to leave it until the last minute to buy a wig.

Synthetic or human hair? When deciding which type of wig to get, consider the person's age and energy level. Many people don't realize that synthetic wigs take less styling and care than human hair wigs. This can make a greater difference than you might think during chemo, when patients are extremely fatigued and find even small tasks taxing. Also, when choosing a wig, ask if the wig size can be adjusted, as a smaller size may be called for as hair falls out. Ask, too, about sticky pads that hold a wig in place to prevent it from slipping.

Try out scarves and hats, and expect changes to the hair

A cancer patient may prefer other head coverings to a wig. Some people find that scarves, hats, and turbans are more comfortable to wear than a wig. (Many people find wigs somewhat itchy and uncomfortable, choosing to wear them only for social occasions or work, and not around the house or with family.) Some specialty stores and wig sellers, such as Hat & Hair and Headcovers Unlimited, also offer hats, turbans, and hair bands that come with fringes of bangs or falls of hair attached in the front or back, a sort of a hybrid between a head covering and a wig. The American Cancer Society's "Look Good, Feel Better" campaign also has suggestions for types of scarves and turbans and new ways to tie them that are flattering. And Just in Time specializes in very soft 100-percent cotton hats and head coverings that are soothing on irritated scalps.

Having a variety of choices helps. Making sure patients have different types of head coverings to choose from can increase their feeling of being in control. A man, for example, might want to have a couple of cold-weather hats or knit caps and another couple of hats for sun protection. A woman might prefer scarves and turbans in a variety of colors. Avoid slippery fabrics, though -- some, such as silk and polyester, tend to slide off a smooth scalp. Cotton and fabrics with a nubby weave or texture hold better. It might sound odd, but a shopping trip to find hats, scarves, and other head coverings can actually be a lot of fun, as well as a way to focus on the lighter side of cancer recovery.

Help the person in your care prepare for and handle changes in her hair. Most cancer patients find that their hair begins to grow back between one and three months after the end of chemotherapy. The big surprise, though, is that the new hair may be very different in texture or type. Many people who formerly had straight hair, for example, find that their hair is curly when it grows back in, at least for a while. It may also be a different color. By acknowledging that this is likely to happen, patients will at least be prepared for the change. The new hair will also be somewhat delicate and brittle at first, so you'll want to keep using a soft brush and wide-toothed comb and wash it with gentle shampoo.