Alopecia (Hair Loss)
The how and when of chemotherapy-induced hair loss
The degree to which hair loss a occurs after chemotherapy depends very much on the precise drugs that are used. For example, the drug Adriamycin, which is commonly used in the treatment of both the early and late stage breast cancer, always causes almost complete hair loss. The drugs paclitaxel ("Taxol") and docetaxel ("Taxotere "), nearly always cause complete alopecia when given in a third weekly schedule, but hair loss is less frequent when the drugs are given in a weekly schedule. Certain other drugs, like Novantrone, cause hair loss in about 20 per cent of cases. Still others, like capecitabine ("Xeloda "), only very rarely cause hair loss. The only way to be certain, is to ask your oncologist specifically.
When hair loss does occur after drugs like Adriamycin it normally does so quite rapidly over a few days, usually about three to four weeks after the first cycle of chemotherapy. The hair comes out suddenly, and in large clumps. You may wake up and find large amounts on the pillow, and large amounts may come out while washing your hair. There is no doubt that this experience is a difficult and confronting one for most people, and it is best to be well prepared. My advice is to get a short haircut at the time that chemotherapy commences, and then, as soon as hair loss begins, go to your hairdresser and have your head shaved. At the time of your first chemotherapy visit, the chemotherapy nurses will give you advice and contacts to enable you to purchase a good wig.
I strongly advise you to focus on the fact that alopecia from chemotherapy is always temporary. The hair grows back at the rate of about one centimetre per month after the last cycle of chemotherapy. The hair grows back slightly thicker and often much curlier. The curls, however, are usually temporary and they tend to grow out as the hair grows longer.
A note on wigs.
Like most things in life, you get what you pay for. If you are willing to pay around $1000 dollars you will be rewarded with a wig that closely resembles your normal hair, and that can be styled in a manner that resembles closely your current hairstyle and hair colour. Most Private Health Funds will allow you around $300-500 rebate on a wig if you provide a letter from your oncologist. I have had positive feedback about the following:
Suzanne's Wigs
Suite 3, Level 6
114-120 Castlereagh St
Sydney, NSW 2000
Mon-Fri 9:00am- 5:00pm
Tel: (02) 9233 4029
Fax: (02) 9233 6149
Parramatta
Phone: (02) 9891 2893
The Individual Wig
Shop 4, 18 - 32 Oxford Street
Darlinghurst (near Hyde Park)
Tel: (02) 9332 2112
Chiquel Wigs Beauty and Hair
101 - 107 Oxford St
Bondi Junction NSW 2022
Tel: 02 8021 6224
Hats.
Don’t forget about hats! They look fantastic, and you can let your creativity go wild. The turban is a popular style for those with chemotherapy-induced alopecia, but there are plenty of others.
The “au naturale” shaved head.
Some of my patients have chosen to make a fashion statement of their shaved head, and it can indeed look extremely dramatic with the right clothes and jewellery. The important point is that no matter which way you choose to manage hair loss, it is a common, every day fact of modern life, and it is not something to be ashamed about.
Scalp cooling
You may hear that cooling the scalp during chemotherapy prevents hair loss. It is true that for certain selected chemotherapy drugs, scalp cooling will minimise hair loss. It is important to note however that it is never 100% effective, and we cannot tell how well it will work on you until you try it.
Scalp cooling works by wearing a silicone cap filled with coolant which keeps the scalp at a very cold temperature during chemotherapy administration. This prevents the chemotherapy from damaging the hair follicles.
What are the "pros" of scalp cooling?
What are the "cons" of scalp cooling?
Haircare tips whilst having scalp cooling:
Whilst having scalp cooling is cold and uncomfortable, many women will put up with the discomfort if it means they will keep their hair. Jenny or myself will discuss this with you if it is something which is deemed suitable in conjunction with your chemotherapy.
The team from the Mater, North Sydney have recently published a paper describing patients' experiences with scalp cooling. To read this paper, click here.
For more information regarding scalp cooling and hair care, click here or visit www.coldcap.com
If I do not decide to have scalp cooling, can I do anything to prevent hair loss?
Regrettably, the answer is usually no. You will hear various stories from friends and relatives about how Auntie Joan had chemotherapy and did not lose her hair. If this is true, Auntie Joan would have received one of the chemotherapy drugs that do not cause hair loss. In the case of the adjuvant chemotherapy of early breast cancer, we have no choice but to use those drugs that have been reliably and repeatedly shown to give the most effective protection from breast cancer recurrence, and currently all of the most effective regimes include drugs from a class called anthracyclines. These drugs include Adriamycin and Epirubicin, and both of these cause complete alopecia. Various naturopath and health food shops may make extravagant claims about certain potions, oils and applications that will minimise hair loss. Similar claims are made about certain Chinese herbal preparations, vitamin E, and various other things. The claims are completely false, and I would advise you to save your money!
My hair is growing back during chemotherapy. Does this mean the chemotherapy is not working?
Hair loss on chemotherapy is due to the sensitivity of hair root cells to the drugs. Individual hair follicles differ in their sensitivity, and some may be over to regenerate hair growth even while chemotherapy is continuing. This does not mean that the chemotherapy has lost its effectiveness, or that you are getting too low a dose. It is just a reflection of individual variability in the hair root follicles.
What happens if I have radiotherapy after my chemotherapy, and then more chemotherapy after that? Will I lose my hair a second time?
A very common schedule for young women with early breast cancer is to have four cycles of what is called "AC ", followed by radiotherapy. In certain selected cases, further chemotherapy with a drug like Taxol is then given. When schedule is used, it is usual for a fine growth of hair to occur during radiotherapy. If the Taxol is then given on a weekly schedule, which is my usual practice, the hair may continue to grow slowly. In other cases, however, it may again fall out. Hair loss with weekly Taxol, however, tends to be more gradual than the sudden loss that occurs on “AC”.
The degree to which hair loss a occurs after chemotherapy depends very much on the precise drugs that are used. For example, the drug Adriamycin, which is commonly used in the treatment of both the early and late stage breast cancer, always causes almost complete hair loss. The drugs paclitaxel ("Taxol") and docetaxel ("Taxotere "), nearly always cause complete alopecia when given in a third weekly schedule, but hair loss is less frequent when the drugs are given in a weekly schedule. Certain other drugs, like Novantrone, cause hair loss in about 20 per cent of cases. Still others, like capecitabine ("Xeloda "), only very rarely cause hair loss. The only way to be certain, is to ask your oncologist specifically.
When hair loss does occur after drugs like Adriamycin it normally does so quite rapidly over a few days, usually about three to four weeks after the first cycle of chemotherapy. The hair comes out suddenly, and in large clumps. You may wake up and find large amounts on the pillow, and large amounts may come out while washing your hair. There is no doubt that this experience is a difficult and confronting one for most people, and it is best to be well prepared. My advice is to get a short haircut at the time that chemotherapy commences, and then, as soon as hair loss begins, go to your hairdresser and have your head shaved. At the time of your first chemotherapy visit, the chemotherapy nurses will give you advice and contacts to enable you to purchase a good wig.
I strongly advise you to focus on the fact that alopecia from chemotherapy is always temporary. The hair grows back at the rate of about one centimetre per month after the last cycle of chemotherapy. The hair grows back slightly thicker and often much curlier. The curls, however, are usually temporary and they tend to grow out as the hair grows longer.
A note on wigs.
Like most things in life, you get what you pay for. If you are willing to pay around $1000 dollars you will be rewarded with a wig that closely resembles your normal hair, and that can be styled in a manner that resembles closely your current hairstyle and hair colour. Most Private Health Funds will allow you around $300-500 rebate on a wig if you provide a letter from your oncologist. I have had positive feedback about the following:
Suzanne's Wigs
Suite 3, Level 6
114-120 Castlereagh St
Sydney, NSW 2000
Mon-Fri 9:00am- 5:00pm
Tel: (02) 9233 4029
Fax: (02) 9233 6149
Parramatta
Phone: (02) 9891 2893
The Individual Wig
Shop 4, 18 - 32 Oxford Street
Darlinghurst (near Hyde Park)
Tel: (02) 9332 2112
Chiquel Wigs Beauty and Hair
101 - 107 Oxford St
Bondi Junction NSW 2022
Tel: 02 8021 6224
Hats.
Don’t forget about hats! They look fantastic, and you can let your creativity go wild. The turban is a popular style for those with chemotherapy-induced alopecia, but there are plenty of others.
The “au naturale” shaved head.
Some of my patients have chosen to make a fashion statement of their shaved head, and it can indeed look extremely dramatic with the right clothes and jewellery. The important point is that no matter which way you choose to manage hair loss, it is a common, every day fact of modern life, and it is not something to be ashamed about.
Scalp cooling
You may hear that cooling the scalp during chemotherapy prevents hair loss. It is true that for certain selected chemotherapy drugs, scalp cooling will minimise hair loss. It is important to note however that it is never 100% effective, and we cannot tell how well it will work on you until you try it.
Scalp cooling works by wearing a silicone cap filled with coolant which keeps the scalp at a very cold temperature during chemotherapy administration. This prevents the chemotherapy from damaging the hair follicles.
What are the "pros" of scalp cooling?
- Minimises hair loss
- Increases self esteem
- Hair regrowth is thicker and quicker
What are the "cons" of scalp cooling?
- Not 100% effective - some hair loss is unavoidable
- Uncomfortable (usually only for first 10-15mins) - the cap is tight and cold
- Prolongs time in the chemotherapy suite (needs to be worn for up to 2 hours post chemotherapy)
- Not suitable for all patients - it depends on the chemotherapy regimen, cancer type.
- Not offered at Norwest Private Hospital.
- Spots are limited to 2 patients per day.
Haircare tips whilst having scalp cooling:
- Wash your hair as infrequently and gently as possible (once or twice a week)
- Don't pile your hair on top of your head and wash vigorously like they do in shampoo ads! This may cause matting.
- Gently massage shampoo into the roots of your hair and scalp.
- Use a gentle shampoo and conditioner which is low in chemicals and perfumes eg. organic / natural products
- Pat hair dry or let dry naturally
- Avoid heat - blow drying on low heat and gentle speed is fine, but avoid hair straighteners!
- Avoid tight hairstyles which pull on the hair eg. buns, tight ponytails.
- Use a soft brush or a wide tooth comb for getting knots out. Be gentle and use lots of conditioner.
- Avoid permanent hair colours and harsh chemical services such as perms. Semi-permanent colours are ok if necessary
- Be prepared for some hair loss. This varies from person to person, but if you are starting to feel uncomfortable or self conscious, ditch scalp cooling.
- Continue this regimen for 3 - 6 weeks following completion of chemotherapy / scalp cooling.
Whilst having scalp cooling is cold and uncomfortable, many women will put up with the discomfort if it means they will keep their hair. Jenny or myself will discuss this with you if it is something which is deemed suitable in conjunction with your chemotherapy.
The team from the Mater, North Sydney have recently published a paper describing patients' experiences with scalp cooling. To read this paper, click here.
For more information regarding scalp cooling and hair care, click here or visit www.coldcap.com
If I do not decide to have scalp cooling, can I do anything to prevent hair loss?
Regrettably, the answer is usually no. You will hear various stories from friends and relatives about how Auntie Joan had chemotherapy and did not lose her hair. If this is true, Auntie Joan would have received one of the chemotherapy drugs that do not cause hair loss. In the case of the adjuvant chemotherapy of early breast cancer, we have no choice but to use those drugs that have been reliably and repeatedly shown to give the most effective protection from breast cancer recurrence, and currently all of the most effective regimes include drugs from a class called anthracyclines. These drugs include Adriamycin and Epirubicin, and both of these cause complete alopecia. Various naturopath and health food shops may make extravagant claims about certain potions, oils and applications that will minimise hair loss. Similar claims are made about certain Chinese herbal preparations, vitamin E, and various other things. The claims are completely false, and I would advise you to save your money!
My hair is growing back during chemotherapy. Does this mean the chemotherapy is not working?
Hair loss on chemotherapy is due to the sensitivity of hair root cells to the drugs. Individual hair follicles differ in their sensitivity, and some may be over to regenerate hair growth even while chemotherapy is continuing. This does not mean that the chemotherapy has lost its effectiveness, or that you are getting too low a dose. It is just a reflection of individual variability in the hair root follicles.
What happens if I have radiotherapy after my chemotherapy, and then more chemotherapy after that? Will I lose my hair a second time?
A very common schedule for young women with early breast cancer is to have four cycles of what is called "AC ", followed by radiotherapy. In certain selected cases, further chemotherapy with a drug like Taxol is then given. When schedule is used, it is usual for a fine growth of hair to occur during radiotherapy. If the Taxol is then given on a weekly schedule, which is my usual practice, the hair may continue to grow slowly. In other cases, however, it may again fall out. Hair loss with weekly Taxol, however, tends to be more gradual than the sudden loss that occurs on “AC”.