Patient Teaching for Managing Hair Loss from Cancer Therapy
Patients undergoing cancer therapy should be informed that hair loss is a common side effect, and they should be offered options including scalp cooling (which can prevent 50-65% of hair loss), wigs, hats, scarves, and other accessories to help manage the psychological impact of alopecia. 1
Understanding Cancer-Related Hair Loss
Chemotherapy-Induced Alopecia (CIA)
- Occurs in approximately 48% of patients receiving chemotherapy 1
- Usually starts 1-3 weeks after beginning treatment
- Typically presents as diffuse grade 2 alopecia (more than 50% hair loss) on the entire scalp
- May also affect eyebrows, eyelashes, and body hair
- Hair regrowth typically begins 2-3 months after completing chemotherapy
- Regrown hair may have different color and texture (occurs in 65% of patients) 1
Endocrine Therapy-Induced Alopecia (EIA)
- Affects 4.4-25% of patients on endocrine therapy
- Characterized by grade 1 alopecia primarily on crown of scalp
- Usually develops between 6-18 months after starting therapy
- More common in post-menopausal women receiving aromatase inhibitors 1
Prevention Options
Scalp Cooling
- The only proven method to prevent chemotherapy-induced hair loss 1
- Most effective with:
- Taxane-based regimens
- Less effective with anthracyclines combined with taxanes or cyclophosphamide
- Protocol:
- Begin cooling 20-45 minutes before chemotherapy infusion
- Continue during infusion
- Continue for 20-150 minutes after infusion (only 20 minutes needed for docetaxel) 1
- Contraindications:
- Hematological malignancies
- Cold sensitivity
- Cold agglutinin disease
- Cryoglobulinaemia
- Cryofibrinogenaemia
- Cold post-traumatic dystrophy
- Whole-brain radiation therapy following chemotherapy 1
Management Options
Wigs and Head Coverings
- Inform patients about:
- Wigs (may require prescription for insurance coverage)
- Hats, scarves, and other accessories 1
- Most insurance plans cover mastectomy prostheses and specialty bras; similar coverage may apply to wigs 1
- Encourage patients to obtain prescriptions for these items 1
Practical Tips for Patient Education
Before Treatment:
- Discuss the likelihood and timeline of hair loss based on specific treatment regimen
- Explore prevention options like scalp cooling if appropriate
- Consider cutting hair short before treatment to reduce psychological impact of shedding
During Hair Loss:
- Use gentle hair care products
- Avoid heat styling, harsh chemicals, and tight hairstyles
- Use soft brushes and wide-tooth combs
- Consider head coverings to protect scalp from sun exposure
After Treatment:
- Explain that hair typically regrows at approximately 1 cm/month 1
- Warn that new hair may have different color or texture
- Recommend gentle hair care as new hair grows in
Psychosocial Support
- Acknowledge that hair loss is one of the most distressing side effects of cancer treatment 2
- Assess for body image/appearance concerns 1
- Refer patients with persistent body image concerns for psychosocial care 1
- Support options include:
- Support groups
- Psychotherapy
- Cognitive behavioral therapy
- Couple-based interventions 1
Resources for Patients
- Inform patients that cancer centers often maintain directories of local resources for wigs and head coverings 1
- Encourage patients to check with their insurance company regarding coverage for wigs and accessories
- Provide information about community support groups focused on body image concerns
Special Considerations
- Young breast cancer survivors may be particularly affected by body image changes 1
- Permanent hair loss (alopecia) is a rare complication of chemotherapy 1
- For patients with EIA, consider checking thyroid function, iron stores, vitamin D, and zinc levels to rule out other causes 1
By providing comprehensive education about hair loss and management options, healthcare providers can help reduce the psychological impact of this common side effect and improve patients' quality of life during cancer treatment.