Alopecia is the loss of all or some of your hair. Hair loss happens in cancer patients because chemotherapy attacks rapidly dividing cells including those in your hair follicles. This hair loss happens all over the body, not just the head, and can be experienced as a thinning of the hair or total hair loss. Alopecia can also be associated with radiation as the treatment damages the hair follicles and can result in either temporary or permanent hair loss in the radiation field. Most patients who lose their hair report negative feelings about the loss of hair including some level of grief and anxiety.
While most people understand that losing one’s hair would be difficult, this is an aspect of treatment that some patients find difficult to talk about. One reason for the difficulty is that people can feel self-conscious about being perceived as vain. Another challenge is that the response patients get can be dismissive such as those who try to offer reassurance by responding with “Don’t worry. It will grow back.” This loss is also minimized by the perception that compared to cancer it “shouldn’t matter”.
As a psychologist who focuses on working with cancer patients, I can say with confidence that this loss does matter and it is often a physical reminder that someone is ill. Alopecia can make patients feel less like a person they recognize when they look in the mirror and more like a patient. There is no right or wrong way to feel about hair loss. For those who are struggling or have questions, here is some information that I would want to share with any patient who is concerned about cancer-related alopecia:
1. Things to ask about: Not all types of chemotherapy cause hair loss so it can be helpful to ask your medical team if hair loss is associated with your type of chemotherapy. For those receiving radiation, it can also be helpful to ask about hair loss in the radiated area. Most cancer centers also have people on staff that can help with education about hair loss. So, make sure to ask your team what resources are available. The good news is the most oncology teams understand how challenging this aspect of the treatment can be and are happy to help patients adjust.
2. What happens: Hair loss usually begins about 2 - 4 weeks after the initiation of treatment. People will begin to notice hair on their pillow, in their underwear or in their hands as they wash their hair. Some people find that their heads are sensitive or tender as their hair begins to fall out. Hair loss will continue throughout that type of treatment and different types of chemotherapy may impact your hair loss in different ways. For example, some people may begin to see growth as they switch regimens.
Your hair will usually begin to regrow several weeks after the completion of chemotherapy. For those who have had radiation it can take several months for hair growth to start. Your new hair may be a different color or texture than you had prior to treatment. For many, the hair begins to grow back and appears white or gray, which may change as the cells that control hair pigmentation begin to regenerate. Your hair may continue to change as it grows in. Hair growth happens at about 1/2 each month so the regrowth process will take some time and does take some patience.
Studies suggest that cold-capping (the use of ice packs or cooling devices on the head during chemotherapy treatment) is an effective strategy for preventing or minimizing hair loss. Here is a link to information from the Mayo Clinic on how the cold cap works: https://newsnetwork.mayoclinic.org/discussion/mayo-clinic-q-and-a-cold-cap-therapy-can-reduce-hair-loss-caused-by-chemotherapy/\
3. Getting Prepared: You can take steps to get ready for treatment and the impending hair loss. Either before beginning treatment or after you have had your first dose of chemotherapy, I usually suggest that patients go to a wig shop and/or get some scarves or hats. Your hospital may have a center available that helps you to get fitted for wigs, hats and scarves. See information below for some resources in the Los Angeles area.
If you decide to try the cold cap then you will need to set that up either through your cancer center or through an outside company. Most facilities have companies that they work with so ask your medical team for information. The cold cap team will provide you with guidelines to help prevent hair loss such as not coloring your hair during treatment.
For many patients, the actual process of seeing their hair fall out is difficult. Many patients find it helpful to get their hair cut shorter before it begins to fall out and then to shave their heads to a short buzz cut as the hair begins to fall out. Although it can be sad or scary to think about taking these steps, people most often report a sense of relief once they have begun to take steps toward taking control over this aspect of treatment.
4. Pamper yourself: It can help to find other ways to focus on feeling good about yourself. Trying new clothing styles, finding fun hats, wigs or scarves or wearing a different type of jewelry such a statement pieces can all be ways to help you adapt to your new look.
Here are some organization that can help you take some time for yourself:
Beauty Bus Foundation is an organization that provides salon treatments to patients and their caregivers. Services are free and are a great way to relax and get pampered.
The Look Good Feel Good Program from the American Cancer Society can also help you feel good about yourself by teaching you some make-up tricks that can help during treatment,
5. Monitor your self-talk: As mentioned earlier, patients sometimes begin to tell themselves that they are vain if they are worried about their hair loss. The truth is that in many cultures our hair becomes an important part of who we are and how we present ourselves to the world. When you see yourself without hair, it is often a reminder that you are sick and that is hard for many people. If you find that you are using a lot of negative talk when thinking about your appearance or your reaction to your hair loss, try to stop and take a moment to offer yourself some empathy. Think about what you might say to your best friend or a close family member and offer the same soothing remarks to yourself. It can also help to talk to other cancer patients or close friends for support and encouragement.
6. Get help if you need it: If you continue to struggle with negative thoughts or a sense of grief or anxiety that begins to impact your daily life, you may benefit from the help of a mental health professional.
Los Angeles Resources
If you are not in Los Angeles, I recommend you checking with your local cancer center or the American Cancer Society for local resources to support you during treatment.
Personal Appearance Center
Roy and Patricia Disney Cancer Center
Providence Saint Joseph Medical Center
501 S. Buena Vista Street
2nd Level
Burbank, CA 91505
818-748-4713
Positive Image Center (open to the community)
City of Hope
1500 E. Duarte Rd.
Duarte, CA 91010
626-301-8874
Reflections Boutique (open to the community)
UCLA Medical Center
200 UCLA Medical Plaza, Suite 163
Westwood, CA
310-794-9090
Image Enhancement Center (open to the community)
USC Norris Comprehensive Cancer Center
1441 E. Lake Ave., Suite 1362
Los Angeles, CA 90033
323-865-3158
Godiva’s Secret Wigs
www.godivasecretwigs.com 818-591-0808
info@GodivasSecretWigs.com
American Cancer Society
Tender Loving Care (Hats, Scarves, Wigs, Bras)
800-850-9445
Look Good Feel Better (make-up)
1-800-395-LOOK
Beauty Bus Foundation (in-home services available)
2716 Ocean Park Blvd., Suite 1062
Santa Monica, CA 90405
310-392-0900
If you have questions about this blog or any information included on this site please feel free to contact Dr. Davidson at info@cancerpsychologist.com.
Dr. Davidson is a health psychologist, in Los Angeles, whose practice focuses on support for those with a range of medical illness. Her specialization in cancer allows her to help patients adjust to their diagnosis, cope with treatment, and transition back to work and family responsibilities after treatment has finished. Dr. Davidson has assisted patients in finding new ways to achieve a greater sense of wellness as they adjust to a "new normal". Her focus is on helping patients improve and maintain the quality of their lives regardless of illness trajectory.
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For more information about Dr. Davidson please visit www.stephaniedavidsonpsyd.com