Chemotherapy and hair loss: How women with breast cancer deal with losing their hair – and how to support them

Most women would agree that their hair plays a big part in their looks and self-confidence. So when cancer strikes and a woman has to start chemotherapy, the impending hair loss can make dealing with the big C even more stressful and emotional.

When my late sister Sally underwent chemotherapy for colorectal cancer in 2003, she, like many patients, started losing her hair. She was in her mid-thirties then, fashion-conscious and always immaculately groomed.

One of the things that comforted her and "normalised" her cancer recovery journey, was to continue to look good. And this included getting a wig.

Sally’s chic wig looked exactly like her own chin-length feathered bob. It was made of real hair and after she bought it, she wore it to her hairdresser who gave her the same wispy layers she had worn for years.

Looking like herself again helped Sally, and everyone else around her, in intangible ways. It didn’t make us forget that she was fighting cancer; instead, it reminded us that despite fighting cancer, Sally could, and would, defiantly look good in her stylish bob.

“Other than our face and dressing, I think our hair matters most as part of our aesthetics – even to someone like me who doesn’t fuss too much with my hair,” observed breast cancer survivor Gemma Foo, 46.

The mum of two teenagers said her hair is an important part of who she is. “For women, our hair is part of our identity. My hairstyles represent the different phases in my life and having a different look – long, bleached, permed, a crew cut, a bob – is like a confidence booster.” 

SHAVING IT OFF BEFORE IT FALLS OUT

For practical and aesthetic reasons, many cancer patients shave their heads in order not to have to deal with the impending hair loss during chemotherapy.

“I knew hair loss would be inevitable as my treatment was quite aggressive. So, I might as well be decisive and shave it all off,” said Foo. She bought a chin-length wig made of real hair for S$1,000. “Like my own hairstyle, it was hassle-free and easy to maintain.”

“I wasn’t really affected by the hair loss personally but I didn’t want to attract unnecessary attention,” she added. “Wearing a wig allowed me to still enjoy those moments of being out with my family and friends.”   

She said that while many patients – mostly women – at her oncologist’s clinic wore wigs, there were a number who also donned head scarves, hats, caps and beanies. “A friend who was diagnosed with lymphoma wore a head scarf because she found it easier; she didn’t see the need to get a wig,” Foo said.

There are online shopping platforms where you can buy headgear for under S$10. Build up a collection to complement your wardrobe, Foo suggested.   

“For many cancer patients, the wig is not just a cosmetic thing. It also buys us time to recalibrate our thoughts and emotions, and our views of how we want to lead our lives. It took me a while to feel confident enough to go without it.

“I knew people would ask me questions about my cancer and by then, I was mentally prepared and could readily share about my recovery journey. Once you hit that stage, you don’t look back.”

To wig or not to wig is a question only a cancer patient can answer for herself (or himself). “Whatever makes you feel most comfortable to help you fight your cancer battle. Fighting cancer is not just about the medication – the mental battle is important too… If getting a wig is not your focus, then go without it,” she said.

SCALP-COOLING THERAPY TO REDUCE HAIR LOSS

A scalp cooling therapy offered by the National University Cancer Institute, Singapore (NCIS) is available to help reduce hair loss during chemotherapy. The therapy is also available at Ng Teng Fong General Hospital.

Dr Joline Lim, the consultant at NCIS' Department of Haematology-Oncology who spearheads the scalp-cooling initiative, said scalp cooling therapy has helped over 500 cancer patients at NCIS reduce hair loss since December 2017.

Ananthini, a 36-year-old with Stage 3 breast cancer, who did the therapy at Dr Lim’s suggestion, said she had benefitted from it. “Hair loss was emotionally distressing and affected my self-esteem. Scalp cooling minimised my hair loss during chemotherapy, and that had a positive impact on my emotional well-being throughout the treatment process.”

The therapy protects the hair follicles from injury caused by chemotherapy drugs delivered through the bloodstream, resulting in faster rates of hair regrowth. At NCIS, the first session costs S$110, and each subsequent visit costs S$76.

“Cooling the scalp constricts the blood vessels there, resulting in less chemotherapy drugs reaching the hair follicles,” said Dr Lim. Cooling too, means less of the drug can penetrate the hair follicle, reducing damage.

NCIS uses the Paxman Scalp Cooling System, in which a lightweight cooling cap made of medical-grade soft silicone is fitted over the patient’s head. Coolant passes through the cap to extract heat from the scalp.

The therapy starts 30 minutes prior to chemotherapy and ends 60-90 minutes after. “A patient can choose to stop scalp cooling therapy any time during the session, or to complete subsequent chemotherapy treatments without scalp cooling,” said Dr Lim.

However, as the aim of scalp cooling is to decrease blood flow to the scalp during chemotherapy, “it needs to be administered at each chemotherapy session to be effective”.

Hair loss is likely to resume once chemotherapy is administered without scalp cooling.

Dr Lim said a local study found that scalp cooling therapy is generally well-tolerated.  “More than 90 per cent of patients reporting the experience as comfortable or better,” she said.

There are some side effects, which include feeling discomfort due to the cold, and experiencing headache, light-headedness or dizziness, and nausea.

Dr Lim added that, anecdotally, patients who undergo scalp cooling therapy report a faster rate of hair regrowth compared with those who did not, which also had a positive impact on their mental wellbeing.