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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 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 the 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 the scalp 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
Ste 2, 1st Flr,99 Elizabeth St
Sydney, NSW 2000
Mon-Fri 9:00am- 5:00pm
Tel: (02) 9233-4029
Fax: (02) 9233-6149


Parramatta
Phone: (02) 9891 2893

Brisbane
(07) 3210 0453

Suite 401, Fourth Floor
227 Collins St (Cnr Swanston St)
Melbourne 3000
Phone: (03) 9560 0622

(Illustrations at right are from Suzanne's Wigs)

The Individual Wig
Shop 4, 16 - 32 Oxford Street
Darlinghurst (near Hyde Park)
Tel: 9332 2112.

I also have patients who have done very well on EBay, including one who bought the best blonde wig I've ever seen for 90 cents plus postage!





Hats.
Don’t forget about hats, girls! 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.



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!
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. However, this is generally only true if certain individual drugs are used. Generally in oncology we have to use drug combinations, and scalp cooling is generally not effective for these combinations. Quite elaborate devices have been constructed to keep the scalp at a very cold temperature during chemotherapy administration. Whilst this is pretty uncomfortable, many women would put up with the discomfort if it worked. Unfortunately, the indications for it are really quite few and your oncologist will alert you if scalp cooling is an option in your particular case.




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”.




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Copyright © 2013, Professor Richard Kefford AM MB BS PhD FRACP. All rights reserved.