In the face of a life-threatening illness and treatment that's sometimes as painful as the illness itself, hair loss might seem like a small worry. But it's just the opposite: For many cancer patients, losing their hair is one of their biggest fears, and one of the most emotionally upsetting experiences of the whole cancer journey. However, there are ways to help someone cope with the emotional side of hair loss.
Try to understand the emotions cancer patients have about losing their hair
Don't be blindsided when the patient finds hair loss upsetting.
It may come as a shock to find out just how big a deal hair loss can be during cancer treatment. You may be caught by surprise when tears well up as your friend or relative pulls clumps of hair out of her brush. "For some patients, hair loss is the thing they dread most about cancer treatment. But caregivers are often much more worried about nausea and fatigue and pain, and they don't understand those feelings," says Brook Benack, an oncology social worker at the Zangmeister Cancer Center in Columbus, Ohio, and program coordinator at the Center's Haven of Hope foundation.
It might feel to you like she's focusing on something superficial at a time when there are more important things to worry about, but it's not nearly that simple, says Benack. "It's a real loss, and patients need to grieve. Losing your hair is a tangible sign that everything is different, and it may trigger deep feelings." The person with cancer needs to be allowed to feel upset and work through it, rather than try to pretend those feelings aren't there. When this change has her feeling down, you should acknowledge it by saying something like, "You must feel really sad. I understand."
Realize that hair loss makes cancer patients feel exposed and vulnerable.
For most people, hair loss is a public announcement of the fact that they've got cancer. All of a sudden, something that's very private -- a life-threatening illness -- becomes public knowledge. Which also means your friend or relative is going to have to field comments and questions from people with whom they may not feel like talking about the cancer. (For a woman who's been pregnant, it's similar to the stage when she starts showing and suddenly everyone asks how far along she is and even tries to touch her stomach.) If a patient is private about health and illness, such intrusiveness can make her feel vulnerable and shy.
Cancer patients often describe losing their hair as feeling like they're walking around with no skin; they feel raw, exposed, and powerless, says Laura Beemiller, also an oncology social worker at the Zangmeister Center. You can help by reminding the person that she doesn't have to respond to any questions she doesn't want to answer. You might even talk about things to say when people intrude with well-meant inquiries. Remind her that it's perfectly acceptable to change the subject with a response such as, "Yes, I'm battling cancer, but let's talk about something more cheerful. How are your grandchildren?"
Understand that feelings about hair loss are feelings about change. When someone is going through cancer treatment and already feels scared and vulnerable, the threat of losing her hair can seem like the proverbial last straw. With everything else changing in her life, it can be overwhelming to face having her appearance change so dramatically. In fact, says Benack, hair loss is sometimes a trigger for depression because a cancer patient feels like so much loss is wrapped up in this event. If she loses her eyebrows and eyelashes, it's even more upsetting because it changes her appearance so drastically. Cancer patients describe looking in the mirror and feeling like they're staring at a stranger. What could be more disorienting than not recognizing yourself? The best way to handle such intense feelings is to encourage the person to talk about them, and always to be a careful listener. Just saying, "I know this is really hard" and "I wish you didn't have to go through this" goes a long way.
Realize that being bright and cheery may not be helpful yet. One common mistake caregivers make is trying to look on the bright side before a patient is ready. "You might say something you think is comforting, like `It'll grow back soon,' making her feel like he shouldn't be so upset even though she is," says Benack. You may also find yourself offering solutions, like "We'll get you a nice wig." But remember that there will be plenty of time to focus on wigs and other head coverings later -- it isn't helpful at the moment someone is feeling distressed.
Other ways to help a cancer patient cope with hair loss
Reassure her that vanity isn't the cause of being sad about losing hair. You'd be surprised how many cancer patients cry when they look at themselves in the mirror -- yet feel guilty for being so upset about something they dismiss as vanity. "She may feel embarrassed about having such strong feelings because it can seem vain, and she knows that family members think she should be focusing on recovery," Beemiller says. But if she's ready to deal with it, you can also encourage her to take positive steps. Bring home hat catalogs, order a few, and have fun trying them on.
But be ready for the vanity issue to come up when she's choosing wigs, hairpieces, hats, and makeup. She might say things like "Oh, it doesn't matter," when of course it really does. It can be difficult for a patient to admit the importance of getting just the right wig or buying paste-on eyebrows, because it seems vain or trivial in the face of everything else that's happening. Offer reassurance that it's okay to be concerned about appearance; you may even have to jokingly agree to banish the words "vain" and "vanity&q
uot; from your mutual vocabulary. Encourage your friend or relative to focus on her looks as much as she feels like it. Say things like, "I want you to feel comfortable and confident, so take all the time you need."
Cultivate patience; what's one more trip to the wig shop if it lifts her mood? Cheer her on when she tries something new. Remember how you felt the first time you had your own hair cut short? Stepping out in a turban or new eyebrows is a similar risk for someone who's lost her hair. Pay lots of compliments: Let her know that her new turban makes you think of Lana Turner.
Help her find someone who's sharing this experience. When it comes to hair loss, no one understands like another cancer patient. Finding someone else who's going through it can be incredibly helpful and important, says Beemiller. If the patient is willing to join a cancer support group, this is a great way to meet other people dealing with hair loss. If not, perhaps your hospital or cancer center could refer her to a fellow patient to talk to. "If she can find someone to talk to who's going through it or has been through it, she won't feel alone, and she can get ideas and suggestions," Beemiller says. "I've seen cancer patients really bond by poring over wig catalogs and hat catalogs, laughing and crying."
Discourage the patient from relying on hair loss prevention strategies.
Many patients read or hear about medications or other therapies for preventing hair loss. The most popular preventive strategy is wearing an "ice cap" during chemotherapy, which is supposed to prevent hair loss. Unfortunately, it doesn't work, says Terry Anders, RN, clinical educator at the Zangmeister Center. "There's no proof that it does anything other than give the patient a bad headache."
Another therapy patients ask about is using Rog aine, the popular balding preventative. However, if your friend or relative's chemo regimen is causing hair loss, then no medication is going to be effective, says Anders. Nor should she mix other medications with the chemo regimen anyway. More important, focusing on hair loss prevention therapies keeps the person from accepting the hair loss and taking steps to prepare for it. "It's a really emotional issue, so people want to prevent it from happening," Anders says, "but over time, most patients do lose their hair. It helps if you can get her to refocus her energy on recovering from the cancer."