One of the most common and outwardly noticeable side effects of cancer treatment is hair loss or alopecia. Many people, women and men alike, are surprised at the emotional impact that losing their hair during cancer treatment can have.
Chemotherapy and Hair Loss
Chemotherapy is the most common type of treatment for blood and marrow cancers like leukemia and lymphoma. However, these powerful cancer-killing medications are not able to tell the difference between cancer cells and your body’s healthy cells. They attack any rapidly dividing cells in your body and unfortunately this includes your hair follicles. The result? Hair loss that can range from a little thinning on the scalp to total body baldness.
Radiotherapy and Hair Loss
Like in chemotherapy, cells with a rapid turnover rate, such as hair follicles, are more susceptible to the toxic effects of radiation therapy. As a result, alopecia is also common in people who receive radiotherapy to their head, such as those with certain types of lymphoma.
If the entire brain is being treated with radiotherapy, total hair loss will result. However, if just a targeted area of the brain is being treated, alopecia will only occur in a patch that is relative to the treatment field.
Why the Scalp?
Chemotherapy affects hairs that are in a phase of active growth, or anagen phase hairs. About 85% of the hair follicles in your scalp are in the anagen phase at any given time. Therefore, this is the most likely site of hair loss.
Other sites of hair on your body, such as your eyebrows and eyelashes, underarms, pubic area, arms and legs, and your beard, have follicles that are usually in a resting phase so they are not typically affected at first. However, after repeated doses of chemotherapy over time, these hairs may be impacted as they enter a growth phase.
As the hair follicle is damaged by chemotherapy, it becomes fragile and hair can break or fall out with little or no trauma.
When to Expect Hair Loss
Hair loss that is related to cancer treatments occurs more suddenly than natural hair loss. You can expect to begin losing hair 1-3 weeks after your first chemotherapy treatment or 2-3 weeks into your radiotherapy regimen.
Your hair may thin out gradually, but in most cases it will come out in clumps or patches. It will likely be especially evident on your pillow when you wake in the morning, or in the shower. It may take only days for complete hair loss to happen, but it could take up to a couple of weeks.
Most people do not experience any symptoms during their hair loss, except for the irritation of finding hair in everything! Others have described a feeling of scalp discomfort or sensitivity for a few days before it occurs.
When to Expect Hair to Return
Hair loss that is caused by chemotherapy is temporary and reversible. Once your chemo regimen is complete, you can expect to see some regrowth in about 4-6 weeks but it may not be complete until 1 or 2 years after therapy.
The treatment for leukemia and lymphoma includes repeated cycles of chemotherapy. You may see fuzzy patches of hair coming back in between cycles but it is not uncommon to lose your hair several times during your blood cancer journey.
Alopecia that is caused by radiotherapy may be permanent or temporary. People who receive lower doses of radiation to their heads may begin to see some regrowth 3-6 months after their therapy is complete. If your treatment involves higher doses of radiation, your hair loss could be permanent.
When hair returns after cancer treatment, it may be a different color, texture (fine or coarse), or type (straight or curly) than you had before. Sometimes, these changes are permanent, but they may not be.
Treatment Factors That Impact Hair Loss
The when and hows of chemotherapy-related hair loss depend on a number of factors. The medications you receive, the combinations of these drugs, how much you get and the timing of them will have an impact.
Certain drugs are more likely to cause alopecia than others. In fact, some chemotherapy does not cause hair loss at all. Medications that are commonly used in the treatment of leukemia and lymphoma that frequently cause hair loss include:
Intermittent infusions of higher doses of medications over a few hours or longer are more likely to cause hair loss whereas lower dose, continuous infusions are less likely.
Ask your doctor or healthcare provider about the specifics of your treatment regimen, and how they predict it will influence your hair loss.
Just as different treatment factors can influence your hair loss, people react differently as well. Some people have more hair follicles in the anagen or growth phase at any given time (“Jeez, your hair grows so fast!”) and will be more sensitive to the effects of treatment.
Also, if you have hair that is damaged by perming, coloring, or other chemical processing before cancer treatment, it may be more vulnerable.
Questions to Ask Your Healthcare Team About Hair Loss
It may not be possible to know exactly how your cancer treatment will impact your hair. However, your healthcare provider may be able to provide you with some information that is more specific to your case. Here are a few questions you may consider asking your healthcare team:
- Is the type of chemotherapy I will be receiving expected to cause hair loss?
- Can I expect hair loss following my radiation treatments?
- Can you predict when I will begin to see hair loss?
- Will the hair loss I experience after radiotherapy be permanent?
- Do you expect complete hair loss from my treatments, or only partial?
- Are there any strategies you recommend for delaying or minimizing hair loss?
- When will my hair come back?
- Are there any resources available to help me cope with my changing appearance?
Summing it Up
Because cancer-killing therapies target all rapidly dividing cells, hair follicles are sensitive to damage by chemotherapy and radiotherapy. This can result in hair thinning or loss that may be permanent or temporary.
In many cases, one cannot know the exact extent, timing or duration of alopecia that a cancer treatment will cause. But certain factors can make hair loss more predictable. Knowing what to expect about treatment-related hair loss can help you to be more prepared, reduce your anxiety, and take control.
Batchelor, D. Hair and cancer chemotherapy: consequences and nursing care- a literature stsudy. European Journal of Cancer Care 2001. 10: 147-163.
Camp-Sorrell, D. Chemotherapy: Toxicity management. In Yarbro, C., Hansen Frogge, M., Goodman, M. and Groenwald S. (eds) (2000) Cancer Nursing: Principles and Practice 5th ed. Jones and Bartlett: Sudbury,MA. (pp.444-486).
Maher,K. Radiation Therapy: Toxicities and management. In Yarbro, C., Hansen Frogge, M., Goodman, M. and Groenwald S. (eds) (2000) Cancer Nursing: Principles and Practice 5th ed. Jones and Bartlett: Sudbury,MA. (pp. 323- 351).