Cancer Hair Loss: Impact Of Cancer And Different Cancer Therapies On Hair And Ways To Deal With It

Hair fall in cancer is one of the most frequently occurring side effects of cancer therapy. It is the most depressing side effect because it constantly reminds people of their illness. In addition to hair loss, changes in hair colour, texture and growth are also common. In fact, cancer hair loss is one of the biggest fears among patients receiving cancer treatment. However, hair loss causes and consequences depend on the individual. For some patients, cancer therapy hair loss is confined only to the scalp, while others might lose hair from their scalp, eyebrows, eyelashes, pubic hair and body hairs too.

Hair Fall In Cancer: Is Hair Loss A Sign Of Cancer?

Hair loss being a sign of cancer and certain types of cancer contributing to hair loss are some of the commonly believed myths. Hair loss does not signify cancer and cancer does not directly influence hair loss. It’s cancer treatments like chemotherapy and radiotherapy which alter hair structure, density, and scalp and not cancer.

"The greater the hair loss, the greater the psychological cost." – Thomas Cash

Cancer therapy hair loss is the most devastating side effect which takes a huge toll on a person’s mental health. In a study conducted by Oliveira, C., and Gameiro, M on adolescent cancer patients, it was found that cancer therapy hair loss significantly contributes to the development of anxiety and depression.

Hair fall in cancer depends on the duration, dose and method of cancer treatment. Cancer hair loss begins within two weeks of starting the treatment. It worsens after one month and usually regrows 3 to 10 months after the course of treatment is over.

Cancer Hair Loss Causes:

“I was going to buy a book on hair loss, but the pages kept falling out.” – Jay London

Cancer treatment involves using medicines and radiations that inhibit rapidly growing cancer cells. Cancer therapy disturbs the normal hair growth cycle. Unfortunately, these medicines also sabotage normal cells that divide quickly. 

Normal cells that undergo rapid division include cells present in the scalp to strengthen hair follicles. When sufficient cell division does not occur, the hair follicles get no nourishment resulting in hair loss. In some cases, cancer therapy indirectly causes hair loss where certain anticancer medicines suppress the blood cell count, leading to anaemia. In such cases, it is anaemia that causes hair loss and not anticancer treatment.
 

Chemotherapy-Induced Hair Loss:

We all know that cancer cells divide more rapidly than normal cells. Chemotherapy involves using medicines to stop the spread of rapidly multiplying cancer cells. However, these medicines also interfere in developing normal cells, including the cells that facilitate hair follicle growth. When the chemotherapy medicines disrupt the cells that generate hair growth, it results in hair loss. This treatment is usually given in cycles, so the hair loss depends on the type of medicine used, dose, and duration of treatment.

Chemotherapy medications that cause hair loss are as follows:

• Doxorubicin
• Docetaxel
• Paclitaxel
• Carboplatin
• Cisplatin
• Cyclophosphamide
• Dactinomycin
• Etoposide
• Ifosfamide 

How Radiation Therapy Causes Hair Loss?

Radiation therapy uses a controlled amount of radiation to kill the cancer cells in order to prevent their multiplication. Hair loss occurs only in the areas where the radiation beam moves in and out of the body. If radiation therapy is indicated for your arm, your hair on the scalp and other parts of the body remains unaffected. Hair may regrow within a few weeks of finishing the treatment, but the hair loss is permanent in some cases.

Effect Of Targeted Therapy On Hair Loss:

Unlike some chemotherapy, hormonal or targeted therapy does not cause complete hair loss. These therapies arrest cancer cell growth by targeting specific molecules or pathways that lead to cancer progression. Some targeted therapies change the hair structure, making it curlier, brittle or changing the texture. Some people might experience dry scalp. 

Targeted therapy does not cause mass shedding or significant hair loss. Your hair might fall out more than usual, and the density might become lesser, but the hair thinning would be barely noticeable. The chances of targeted anticancer medicine to cause hair loss is 15%. Here are some of the targeted cancer therapies that result in hair loss:

• Vismodegib
• Sorafenib
• Vemurafenib
• Regorafenib
• Nilotinib
• Dabrafenib 

Effect Of Hormonal Therapy On Hair Loss:

Hormonal drugs tend to cause mild to moderate hair loss or hair thinning. The hair thinning might be evident at the frontal part of the head or the crown. When you take hormonal drugs for breast cancer, it lowers your estrogen levels, resulting in the lower growth of hair follicles. Some hormonal cancer medicines that result in hair loss are:

• Fulvestrant
• Tamoxifen
• Anastrozole
• Letrozole 

Usually, hair loss due to cancer therapy with hormonal drugs will be noticeable after six months to 2 years of continuous treatment. You will experience lesser hair loss after the first year, but the hair thinning lasts as long as you continue taking medicine. Your hair will grow back after a few months of completing the course of treatment.

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Tips For Dealing With Hair Fall In Cancer:

Since hair loss is the most obvious cancer therapy side effect, it is completely normal to feel anxious or sad. You might experience feelings of anger, anxiety and acceptance. Discuss with your healthcare provider to check whether the medicines you are taking cause hair loss. Here are a few methods to cope with hair loss after cancer therapy:

• Preparing for hair fall in cancer: No matter how informed you may be about it, losing hair is never easy and it takes time to prepare yourself when it actually happens. You may choose to cut your hair or shave them before your treatment starts. You can directly cut it short or in stages to prepare yourself.
• Use accessories to cover hair loss: Some people prefer to cover their heads with wigs, scarfs, hats, etc., while others do not mind covering their heads at all. If you like wearing wigs, start looking for one before you begin your treatment because finding the right wig takes time.
• Pay attention to your hair care routine: If you are suffering from cancer hair loss, practice gentle hair care habits like washing your hair with mild shampoos, using a soft baby brush for combing and using oil or moisturizer when the scalp is dry or flaky.
• Stay away from hair styling devices: Do not use heat devices like straighteners, curlers or hair dryers. Avoid using perms or hair colours on thinning hair. Ask your physician before you go for hair colouring, straightening or any other hair treatments.
• Protect your scalp: As you lose hair, your scalp gets exposed to sun which causes further damage. Ensure that you apply sunscreen and wear hats before you step out in the sun.
• Hypothermic caps: Cool cap or hypothermic cap is a new therapeutic device specifically designed for patients suffering from cancer hair loss. It cools down the scalp and helps prevent or minimize hair loss due to cancer therapy. A study conducted by A. Chan et al. revealed that patients receiving chemotherapy with taxanes found scalp cooling helpful to combat hair loss. However, discuss with your physician before you start using one.

As your hair begins to grow back after completing the course of therapy, you might notice that your new hair is thinner, rougher or of a different colour compared to how it was before treatment. A hairdresser might be able to help you with different styling techniques if you have partial hair loss.

Anybody suffering from hair loss would freak out because they experience a sense of shock. If you feel embarrassed, angry or depressed, reach out for help to a mental health practitioner and understand how to deal with your feelings. Talk to your physician regarding what to expect from your cancer treatment and how to cope with hair loss.
 

Talking to close friends and family members you trust regarding how you feel about hair loss could help. If possible, join support groups and gatherings where you meet people who have been through the same.