Approximately 65% of individuals undergoing chemotherapy will experience chemotherapy-induced hair loss, which is usually temporary and completely reversible when therapy ends. Show It is estimated that more than 1.5 million new cases of cancer will be diagnosed in the United States this year, with nearly 600,000 individuals dying from the disease.1 The most common cancers expected to be diagnosed in 2015 include breast cancer, lung cancer, prostate cancer, and colorectal cancer.1 These cancers require different forms of treatment, which often depend on the stage and type of cancer in addition to several other patientspecific factors. Cancer therapy can have adverse effects (AEs), often due to effects on healthy tissues and organs. Weight loss, vomiting, infection, nausea, and hair loss are ranked as the most feared AEs associated with cancer treatment.2 Approximately 65% of individuals undergoing chemotherapy will experience chemotherapy-induced hair loss, which is usually temporary and completely reversible when therapy ends.3 The use of molecularly targeted agents in cancer treatment has also been associated with hair loss rates as high as 60%. Chemotherapy-induced hair loss has been shown to lower patient self-esteem and deprive patients of their privacy because the public commonly associates hair loss with cancer. Forty-seven percent of female cancer patients consider hair loss to be the most traumatic aspect of chemotherapy, with 8% of them stating they would decline treatment for fear of hair loss.4,5 Hair loss associated with cancer treatment is related to the selected anticancer agent(s) and the treatment regimen. Chemotherapy-induced hair loss most commonly affects the scalp, although armpit and pubic hair, eyebrows, and eyelashes may also be lost. The hair loss can be seen within days to weeks of the initiation of therapy, with complete loss occurring 3 months after therapy has begun. Hair often begins to grow back in 1 to 3 months after therapy ends, with some patients experiencing differences in hair thickness, color, or texture upon regrowth.4,5 Chemotherapy is thought to cause hair loss by attacking rapidly diving cells in the body, including the dividing hair matrix cells, one of the fastest growing cell populations in the human body.6 The cause of hair loss associated with molecularly targeted agents has not been thoroughly investigated. Each chemotherapy agent has a different probability of inducing hair loss (Table 13,8,9,12), and using a combination of agents may be more likely to cause hair loss compared with using 1 agent.3 Prevention and Management Many preventive measures have been attempted to reduce chemotherapy-induced hair loss. However, at present, there are no approved pharmacologic interventions to evade the hair loss associated with cancer treatment.7 Therapeutic approaches include decreasing drug delivery to the dividing hair bulb and pharmacologic interventions to block the hair loss effect (Online Table 27). Table 2: Preventing Hair Loss7 Decreased drug delivery: â— Scalp tourniquet â— Scalp hypothermia Adverse effects: â— Headache; â— Varying degrees of nerve compression â— Headaches, claustrophobia Pharmacologic interventions: â— Topical minoxidil 2% â— Burning/irritation of treatment area â— Unwanted hair growth elsewhere on body Decreased Drug Delivery Two mechanisms used to reduce the amount of chemotherapy reaching the scalp include a tourniquet or the induction of scalp hypothermia. The tourniquet is a pneumatic device placed around the hairline that inflates during infusion, resulting in mechanical obstruction of blood flow to the scalp. These tourniquets are worn for 5 to 10 minutes before chemotherapy until 30 minutes after completion.11 In studies to prove this technique’s effectiveness, the data are difficult to interpret.3 Scalp hypothermia causes vasoconstriction of the blood vessels and limits medication absorption on the scalp. Study results from this technique are also difficult to interpret, however, as many experiments use various temperatures and other methods. The cooling is started 5 minutes before chemotherapy and continued up to 1 hour following completion.11 There is concern that scalp cooling may protect scalp metastases from the effects of therapy.3,10 Pharmacologic Interventions Many pharmacologic interventions have been suggested to reduce or prevent hair loss; however, none have been proven so. Topical 2% minoxidil has an unclear mechanism of action, but is thought to modify the hair cycle by prolonging the anagen phase.3 This medication is applied to the scalp 24 hours before treatment and continued throughout therapy and up to 4 months following therapy.10 It has not been shown to prevent hair loss, but it has shortened time to regrowth and lengthened the time to maximal hair loss.3 Other agents, such as cyclosporine A, AS101, calcitriol, cyclin-dependent kinase 2 inhibitors, and tocopherol, have all been used to prevent chemotherapyinduced hair loss with minimal success.11 Conclusion Although there is no proven method to prevent hair loss associated with cancer treatment, there are methods to help manage it once it has begun (Online Table 3). Education regarding this topic is extremely important, and patients should be counseled on their options. Table 3: Methods to Help Manage Hair Loss11,12 Avoid physical or chemical trauma to the hair (eg, bleaching, coloring, perming, using hair dryers that are too hot, using curling irons or hot rollers). Use gentle hair care techniques throughout chemotherapy. Use a satin pillowcase for sleeping because it is less likely to attract and catch fragile hair. Use a soft-bristle hairbrush. Wash hair only as often as necessary. Use a gentle shampoo. Cut hair short or shave hair. Short hair tends to look fuller than long hair and is less noticeable when the hair is shed. Hair that has been cut short may help patients transition to total hair loss. Shaving the head may be easier for securing a wig or hairpiece. Use a sunscreen, hat, scarf, or wig to protect the scalp from the sun. Dr. Moore is an assistant professor at Howard University College of Pharmacy. References
Hair loss is a common side effect of cancer treatment. Hair loss can happen as a side effect of chemotherapy, targeted therapy, radiation therapy, or a stem cell (bone marrow) transplant. These cancer treatments can harm the cells that help hair grow. It can affect hair all over your body, including your head, face, arms, legs, underarms, and pubic area. The medical term for hair loss is alopecia. Hair loss is different for everyone. You might lose all your hair or only sections of it. It might come out slowly over time or become thin. Or you might simply notice that your hair is dryer and duller. Lost hair usually grows back after cancer and treatment. But sometimes, hair stays thin. Hair loss can be challenging regarding both your physical appearance and emotionally. Managing side effects is an important part of your cancer care and treatment. It is called palliative care or supportive care. Talk with your health care team about coping with hair loss. Some cancer treatments can cause hair loss. There can also be other reasons to lose hair, such as thyroid problems or low iron levels. The information below describes certain cancer treatments that may cause hair loss. The best way to find out if you are likely to experience hair loss due to cancer treatment is by talking with your cancer care team. They can tell you if you are likely to lose your hair, and if so, when, due to your treatment plan. ChemotherapyNot all chemotherapy causes hair loss, but some chemotherapy drugs are more likely to cause hair loss or thinning. They include:
This category also includes chemotherapy given as part of a stem cell/bone marrow transplant. Hair does not usually fall out as soon as you start chemotherapy. It usually takes several weeks or cycles of treatment and tends to fall out 1 or 2 months into treatment. How much hair you lose depends on the drug and the dose. It also depends on whether you get your chemotherapy as a pill, into a vein, or on the skin. And, the amount of hair loss is different for each person. You and someone else can take the same drug for the same cancer and still lose different amounts of hair. Hair usually starts to grow back 1 to 3 months after chemotherapy ends. It often takes 6 to 12 months to grow back completely. It may grow back thinner, coarser, curly, or a different color. Hair usually goes back to normal over time. Radiation therapyRadiation therapy only affects the hair on the body part where the radiation is aimed. For example, if you have radiation therapy to the pelvis, you could lose pubic hair. Hair loss depends on the dose and method of radiation therapy. It usually grows back after several months, but it may be thinner or a different texture. With very high doses of radiation therapy, hair may not grow back. Targeted therapyCancer medications called targeted therapy do not cause complete hair loss. But the following targeted therapies may cause hair to become thinner, curlier, or drier than usual.
Hormonal therapySometimes, hormonal therapy for cancer can cause a person's hair gets thinner. This may happen several months to years after starting therapy. Hormonal therapy does not usually cause complete hair loss. The following hormonal therapies are more likely to cause hair loss.
Managing your hair lossLosing your hair can cause more than a change in your physical appearance. It can be an emotional challenge that affects your self-image and quality of life. It is important to be kind to yourself during this stressful time. People cope with hair loss in different ways. Thinking about how you feel most comfortable in managing hair loss before, during, and after treatment may help. And, your choices may change over time.
Cold cap therapyWearing a cap that cools the scalp can help prevent hair loss from drugs given through a vein. This treatment is called scalp cryotherapy. You wear the cap before, during, and after chemotherapy. The cold makes the blood vessels in the skin of your head narrower. Less blood and less of the chemotherapy drug reaches your hair follicles through the blood vessels. Keeping your scalp very cold also helps prevent damage to the hair follicles. Talk with your health care team to learn if cold cap therapy is available and might work for you. MedicationsAn over-the-counter medication called minoxidil may help thinning hair from hormonal therapy or targeted therapy. It may also help if your hair does not grow back completely after chemotherapy, radiation therapy, or a stem cell/bone marrow transplant. There are also other medications you can take by mouth. These include spironolactone (Aldactone) and finasteride (Propecia, Proscar). Hair and scalp careHere are some tips to take care of your hair and scalp during cancer treatment.
Talk with your health care team before using any products, including creams or lotions, that claim to help hair grow back. Wigs and hairpiecesYou may choose to wear a wig or hairpiece when you start losing your hair. Here are some tips that might help.
Caring for hair that grows backWhen your hair begins to grow back, it will be much thinner and more easily damaged than your original hair. It may also be a different texture or color. The following tips may help you take care of the hair that grows back.
Questions to ask the health care teamYou may want to ask your cancer care team the following questions.
Related Resources4 Things to Ask About Cancer and Hair Loss Can Scalp Cooling Stop Hair Loss from Chemotherapy? Side Effects of Chemotherapy Side Effects of Radiation Therapy One Family's Mission to Stop Hair Loss from Chemotherapy: Your Stories Podcast More InformationThe Look Good, Feel Better Program Hope Scarves National Wigs For Cancer Society (NWFCS)
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What is the expected outcome related to hair loss for a patient who is undergoing chemotherapy?
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