For many people with cancer, the loss of one's hair can be one of the most emotionally upsetting aspects of coping with cancer. It is, of course, a visible sign of the presence of your illness. Every day, as you look in the mirror, you are reminded that you have cancer, and that your life has been disrupted in many, many ways. You don't look like yourself, even to yourself, and having to adjust to a dramatically changed appearance can take a toll on even the strongest survivor.

It's important to understand that not all chemotherapy medications will cause total or some amount of hair loss; ask your health care team about the usual reaction to the medications you will take. For patients receiving radiation to the head, hair will fall out only on the part of the head where the radiation is delivered. Unfortunately, hair loss from radiation is almost always permanent.

Hair loss from chemotherapy occurs because some anticancer drugs are made to kill fast-growing cancer cells. However, certain normal cells also multiply quickly — and chemotherapy usually affects these cells as well. Hair follicles (like cells in the bone marrow and intestines) are fast-growing normal cells, and so the chemotherapy can affect these cells, too.

The good news for people facing cancer-related hair loss is two-fold:

First, there are effective ways to cover your head, if you choose. Through excellent programs like the Look Good…Feel Better® Program, developed by the Cosmetic, Toiletry and Fragrance Association (CTFA) and sponsored by the American Cancer Society (ACS), you can receive advice and training on using wigs and scarves, as well as makeup and other grooming issues. This program is available nationally and in Puerto Rico, and has international "sister" programs. To find a program near you, call 1-800-395-LOOK (1-800-395-5665), visit the website, www.lookgoodfeelbetter.org, or check with your local ACS office or your hospital's oncology center.

Second, for almost all people, hair begins to grow back several months after your chemotherapy treatment ends. While this hair initially may be of a different texture and even different color than your original hair, this difference is usually temporary.

Symptoms

Hair loss usually begins in people taking certain chemotherapy medications several weeks after the first or second treatment — but this varies from person to person. Your hair may begin thinning gradually before falling out in larger amounts. Some people say their scalp feels somewhat sore and tingly as the hair begins to fall out.

Treatment

The best response to expected hair loss is to plan ahead; preparedness makes this experience less frustrating. Take these steps to help reduce your anxiety and sense of loss:

• Get your wig before you lose a lot of your hair.
  
  
  • Many insurance companies will cover all or part of the cost of a wig (hair prosthesis) if it is prescribed by a physician as part of cancer treatment. Unfortunately, Medicare will not pay for wigs. If you must pay for your own wig, remember that it is a medical deduction, for tax purposes.
    
    
  • If the expense of a wig is a concern, it may be possible for you to purchase or borrow a wig through the services provided by the American Cancer Society. Contact your local chapter for information and help. Also, organizations like Y-ME, the breast cancer advocacy organization, sometimes has wigs available. Speak with your hospital oncology social worker for additional resources and ideas; some hospitals also have wigs available for their patients.
    
    
  • As your health care team social worker or hospital staff for names of hair care professionals who work with wigs for patients; they will be best able to help you select, cut and manage a wig.
    
    
    • Plan to spend time selecting your wig, trying on numerous possibilities until you are satisfied that you're comfortable with your appearance.
      
      
    • Bear in mind that it can a few weeks for a custom-made wig to be ready…so plan ahead in selecting yours so it will be ready in ample time.
      
      
    • Consider purchasing two wigs. This gives you choices, and means you'll always have a clean, fresh wig available.
      
      
    • Talk with wig professionals about the various advantages and disadvantages of kinds of wigs, such as synthetic wigs, wigs made of human hair, wigs that are part synthetic, etc. Each requires a different level of care from its owner (although some wig salons will care for them for you, at a cost) — and this may be a consideration as you go through treatment.
    
    
  • Wigs are also available through catalogs and by telephone order, but getting a wig this way means you'll have to learn to cope with it by yourself. Bear in mind that many wigs sold over-the-counter or by catalog are initially "too hairy," meaning that to look more natural, trimming and styling by hair care professionals is needed.
    
    
  • Even if you think you may not want to wear a wig, give some consideration to purchasing one "just in case." Some people choose to wear their wigs only some of the time, such as in workplace or social situations, and go bareheaded or use a scarf other times. This is, of course, a very personal decision — but if you lack a wig or other hair covering when your hair initially falls out, your choices are limited at this critical time.
  
  
• Be gentle with your hair as it falls out.
  
  
  • Have your hair cut short before it falls out. It may make your remaining hair look thicker for a while; it will make fitting a wig easier; and it will make cleaning up after your falling hair a bit easier.
    
    
  • During the period before your hair falls out, use mild shampoo and conditioner, and dry your hair on very low heat. Consider letting it air-dry if possible.
    
    
  • Avoid using curling irons, curlers, and even hair ornaments.
    
    
  • If possible, avoid having your hair dyed.
    
    
  • Be considerate of your newly-uncovered scalp.
    
    
    • As your hair thins, your scalp becomes vulnerable to the sun. Wear a hat or scarf outdoors. Sunblock helps, too.
  
  
• Explore options beyond a wig.
  
  
  • Many cancer patients who choose to cover their heads most of time choose to wear scarves, turbans or hats.
    
    
  • The Look Good… Feel Better® Program is an excellent way to learn to wear scarves and turbans and other head coverings in a way that suits you. Ask your oncology social worker when the program will be held in your area; there is no cost involved.
    
    
  • Going without covering of any kind is always an option — although a chilly one in colder climates.
  
  
• When your hair begins to grow back in (usually several months after chemo ends):
  
  
  • Your new hair, which may have a different texture and color than your hair did before chemo, will be delicate and often fine in texture. Use very gentle shampoos and light conditioners.
    
    
  • Wait several months after regrowth begins to have your hair dyed or to have a permanent; discuss this with your hairdresser.
    
    
  • If your scalp is still sensitive, coloring hair and getting a permanent may be painful. If so, postpone these treatments until the sensitivity passes.

Questions for Your Doctor

In managing hair loss, your health care team may include your hairdresser, a wig expert, a nurse and a social worker.

1. Will my cancer treatment (chemotherapy, radiation) cause me to lose some or all of my hair?
   
   
2. When is hair loss likely to start?
   
   
3. If my hair doesn't fall out from my treatment, does this mean the chemotherapy isn't working well?
   
   
4. Can you provide me with information on managing the hair loss process and arranging for head coverings? Where can I go for help?
   
   
5. Please provide me with a prescription for a "hair prosthesis" (wig), for my insurance company.
   
   
6. If financial circumstances make it difficult for me to purchase a wig, where might I locate help in making other arrangements?
   
   
7. How long after my chemotherapy ends will it likely be before my hair begins to grow back in?