Distressing Side Effect
With some types of chemotherapy, an unfortunate side effect is that hair follicles are killed along with the target cancer cells. Hair loss may occur only on the head or include eyelashes, eyebrows and body hair as well. Certain drugs used to treat breast cancer intravenously, such as Taxotere and Adriamycin, are more likely to cause hair loss or thinning. Some chemotherapy regimens used for later-stage breast cancer or other types of cancer don't cause hair loss, says Dr. Kathryn Ruddy, an oncologist, researcher and associate professor of oncology at the Mayo Clinic in Rochester, Minnesota.
However, she says, "the standard therapy regimens we give for early-stage breast cancer – meaning we think we can cure the disease with the chemotherapy – those unfortunately almost do universally cause hair loss." Ruddy tells her patients it usually takes about six months after the last dose of standard chemotherapy for the hair to grow back and for most people to feel comfortable without a wig. "Thankfully, most patients regain a full head of hair," she says. Hair usually grows back curlier, at least initially, and sometimes the color is different. While hair looks thinner while growing back, she says, most people end up with as much thickness as they had before. Chemo-related balding tends to bother women more than men. For some patients, Ruddy says, hair loss "can be the most troubling and difficult side effect of chemotherapy."
Beating Chemo to the Punch
Crollman, a graduate program coordinator with the Eshelman School of Pharmacy at the University of North Carolina–Chapel Hill, was diagnosed in July 2015. She was well-informed about chemotherapy side effects, including the impending hair loss. "As women, we use hair to define who we are," Crollman says. "And feeling like that part of your identity is going to be stripped away makes you feel very vulnerable and almost naked. To feel like you don't have that to hide behind. So I was very scared about that aspect of the chemotherapy." She decided to shave her head. "Cancer takes so much from you in terms of choices that you have, opportunities lost," she says. "Your body is going to be changing and you have to go through these treatments. Shaving my head was a way for me to regain some control of the situation and for me to choose when it was going to happen." Crollman and her husband hosted a head-shaving party at a local hair salon, which they had to themselves for the occasion.
They served wine and cheese to family and friends. First, Crollman shaved her husband's head. Next, a professional stylist gave Crollman a buzz cut. As prepared as she felt, she says it still felt traumatic. "Lots of tears," she recalls. The other shoe dropped when chemotherapy left its mark, Crollman says: "Then when it starts to fall out, you realize: OK, now I'm officially bald." "Most cancer centers recognize that this is a major psychological issue and we need to do as much as we can to support patients," Ruddy says. Nurses and other team members do a lot to educate patients on resources for hair loss. One step is writing a prescription for a wig, which is usually covered by insurance. The Mayo Clinic has an onsite wig shop. Even if patients chose not to get a wig there, Ruddy says, it's helpful to stop in because the staff is so knowledgeable about hair loss and hair coverings. Ask what your cancer center can do for you. Caps that cool the scalp during chemotherapy may help some women preserve their hair. An industry-funded study, reported in December at the San Antonio Breast Cancer Symposium, found among women with breast cancer who underwent four cycles of chemotherapy, those who used the scalp-cooling apparatus while receiving chemo were more likely to retain at least some of their hair.
But the close-fitting caps can cause headaches and are costly at more than $1,000 throughout treatment. Results vary with the caps, partially depending on the individual chemotherapy regime, Ruddy says, and it's unclear whether they're effective enough to make the discomfort worthwhile. "It's not that comfortable to wear basically an ice cap during chemotherapy, and it does extend the amount of time someone needs to get the infusion," she says.
Coping in Style
Doctors at the N.C. Cancer Hospital in Chapel Hill, where Crollman was treated, referred her to the in-hospital boutique to view the selection of wigs, scarves, wraps and hats. Crollman found that she preferred not having a wig in the same style or color as her pretreatment hair. When she first tried matching that look, she says, "It was horrible. It felt like a fraud." Instead, a shorter, lighter-colored wig felt much more comfortable, she says – like creating a new persona instead of trying to re-create what she'd lost. Individuality and sense of style don't disappear with a woman's hair.
Many women use head scarves, some homemade, although Crollman preferred not to. "Some women I know wear the head scarf and look beautiful and rock it and feel really confident that way, so more power to them," she says. About halfway through her treatment, Crollman decided to shed her wig and break out bald. "It was itchy," she says. "I was tired of wearing it. And I had spent the weekend at home sick, laying around. Something in me just switched, and I said, 'I'm just going to wear the bald head.'" Wigless, she went to work, where colleagues were supportive as ever. From that point on, she never wore a wig or scarf again. Crollman wants to help other young women as they continue to work, socialize and simply care about their appearance in the midst of cancer treatment. In addition to blogging, she serves as a Living Beyond Breast Cancer Young Advocate. She's still receiving some treatment, and while she has good days and bad days, she says, "Mentally, I'm in a really good place now."
