Chemotherapy and Hair Loss: All Is Not Lost

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Quick summary

"Will I lose my hair?" may well be one of the first questions cancer patients ask the doctor as they prepare for chemotherapy. And it may come as a surprise to you just how anxious and upsetting you (or the person you're caring for) will find this particular side effect. "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."

To make hair loss less traumatic for you--or the person you're caring for--it's a good idea to learn as much as possible about what to expect and to take practical steps to prepare for what's ahead.

Find out which chemotherapy agents the doctor plans to prescribe.

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 a patient takes, 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.

The way the 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 will be used, so you can learn more about its potential effects -- regarding hair loss and other health issues as well.

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).

Plan ahead to prepare for hair loss.

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, a patient will start to notice hair -- either clumps or individual strands -- on her pillow, hairbrush, and in the drain after showering. Often the peak point of hair loss is about two months into treatment. It's normal to keep losing hair through the entire chemo process and for about a month after the last treatment. Then her hair will start to grow back.

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 your mother has long hair, I'd suggest that she go to the hairdresser and get her hair cut shorter. If she's 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."

Plan in advance to purchase a wig.

If someone wishes to get a wig or hairpiece (and yes, many men do take this option!), you'll want to help her make this purchase in advance. For one thing, she may face a bit of "sticker shock" when shopping for a wig, because good-quality wigs can cost upwards of $200 or more. 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 she 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 make sure she's reimbursed. Be aware, too, that in smaller towns or rural areas it may be hard to find a wig store.

If she can't afford a wig, 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.

Instead, take her wig shopping before the start of chemo. She'll have more energy, and she'll also have the advantage of being able to show the salesperson the color, texture, and shape of her hair, and the store can style a wig to match it as closely as possible.

When deciding which type of wig to buy, take age and energy level into consideration. 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 she's extremely fatigued and finds even small tasks taxing. Also, when choosing a wig, ask if the wig size can be adjusted; she may need a smaller size as she loses hair. Ask , too, about sticky pads that hold a wig in place to prevent it from slipping.

Try out scarves and other head coverings.

Some cancer patients 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 very flattering. And Just in Time specializes in very soft 100-percent cotton hats and head coverings that are soothing on irritated scalps.

Making sure someone going through chemotherapy has a variety of head coverings to choose from can increase his or her 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.

Expect hair to change after chemotherapy.

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, you'll be helping the person you're caring for prepare for the change. The new hair will also be somewhat delicate and brittle at first, requiring a soft brush and wide-toothed comb; it's also a good idea to wash it with gentle shampoo.

Melanie Haiken

Melanie Haiken discovered how important it is to provide accurate, targeted, usable health information to people facing difficult decisions when she was health editor of Parenting magazine. See full bio