Counseling Patients to Cope with Hair Loss

Alopecia is not a life-threatening aspect of the cancer trajectory, but it is described by many patients as one of the most traumatic side effects of chemotherapy and a constant reminder of the cancer and its treatment.

Hair loss may cause a variety of embarrassing and uncomfortable problems, such as shedding of hair, obstacles to routine hair grooming, scalp sensitivity or tenderness, and difficulty maintaining body heat, especially at night. The psychological effects of hair loss include appearance issues such as negative feelings about one's body -- feelings that result in low self-esteem and fear of how an altered appearance will be perceived by others.

Counseling regarding hair loss should begin before the patient begins treatment. Individual cancer therapies include various drug combinations, and each person responds differently to their drug regimen. With this in mind, patients should be informed that hair loss is likely, but may or may not occur. A common and unfortunate effect is that this reinforces a patient's belief that "it won't happen to me." Consequently, they often delay seeking assistance until after hair loss has already begun and their personal esteem has suffered a good deal of damage. It is important to assess the patient's knowledge and attitudes about hair loss and provide needed education.

Our society places great importance on appearance, and because of this, education and support services to help patients adjust to hair loss can make a significant contribution to their quality of life. Local branches of the American Cancer Society often have information available and some have even established wig swap or borrowing services.

Questions and Answers Regarding Hair Loss

Listen below are several questions that are frequently encountered by physicians, followed by a brief recommendation on how to respond.

Q: What does hair do?
A: Hair protects the surface of the skin, conserves body heat, and plays a major role in self image.

Q: Why does hair fall out?
A: Cancer cells grow rapidly and uncontrollably. Chemotherapy affects any cell that grows rapidly, including hair cells.

Q: How much hair will I lose?
A: Chemotherapy affects all body hair, and since hair on the scalp is in an active growth phase more often than any other body hair, this is the hair that chemo most often effects. For those receiving chemotherapy, this condition is always temporary, and the degree of hair loss is drug and dose dependent.

Q: When will my hair fall out?
A: Hair loss usually occurs 2 or 3 weeks after chemotherapy or radiation treatment begins. Hair loss may be sudden or gradual.

Q: What are my head cover choices?
A: One wig and several turban styles may be necessary during and for a period after cancer therapy. A wig should be natural-looking, should stay in place, be easy to care for, comfortable to wear, and reasonably priced. A soft-shoulder pad can be tucked inside a hat or turban to provide fullness and a more natural look.

Q: What should I do if I lose my eyelashes or eyebrows?
A: A visit to a make-over specialist is helpful to learn eyelash and eyebrow application. Dark-rimmed glasses with or without prescription lenses will help to frame the face and distract from facial hair loss.

Q: When will my hair grow back?
A: Hair often begins to grow back during chemotherapy treatment. Hair regrowth will not begin until several months after radiation therapy is completed. Hair grows by forming new cells at the base of the root. Scalp hair usually grows about a half an inch each month, but sometimes vitamins help bolster hair loss for patients with slower hair growth. It is important that the patient realize that new hair may be a slightly different texture or color than it originally was.

Source: Questions answered by Joanna Lombardo Ehmann, RN, OCN, a nurse consultant specializing in body image and self-esteem for cancer patients.