Preventing Chemotherapy-Induced Hair Loss: Issues and Methods

woman wearing head scarf after chemo

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Hair loss is one of the most dreaded and distressing symptoms of chemotherapy for cancer, and many people have wondered if it's possible to prevent it from happening. In recent years, methods such as scalp cooling have become available that are quite effective for some people. Like anything, these methods can have limitations and side effects of their own. What do you need to know to make the best choice regarding your own hair loss during treatment?

Is Preventing Chemotherapy Hair Loss Possible?

A few methods have been tried for preventing chemotherapy-induced hair loss, although success has been mixed. Some people have found these helpful, but others have found them ineffective, or only partially effective, preferring the option of wigs or scarves to thin hair. It does appear to be more effective with some chemotherapy drugs than others. Even though scalp cooling has only recently "taken off" as a common prevention method, it first became available over 30 years ago.

There are also other issues of concern to oncologists. Let's look at the potential issues related to hair loss prevention methods and the methods that are currently available.

Issues in Hair Loss Prevention During Chemotherapy

Any time a treatment is used to counteract the side effects of another treatment, there are issues to be considered. With regard to preventing chemotherapy hair loss, some of these issues include:

Spread of Cancer 

Some oncologists are concerned (especially when treating blood-related cancers like leukemia) that scalp cooling may prevent chemotherapy drugs from reaching all cancer cells, and that spread of cancer to the scalp may be more likely when this is used.

Discomfort

It goes without saying that sitting with an ice pack on your head during each chemotherapy session could be uncomfortable.In fact, the discomfort associated with wearing an ice pack is one of the reasons many people choose not to pursue these treatment.

Cost

The cost of renting the equipment to apply an ice pack can be prohibitive for some people.

Logistics

Scalp cooling is a relatively new phenomenon in the chemotherapy infusion center, and many centers aren't set up to incorporate scalp cooling into the schedule. This may result in delays, as well as detract from other patients on the ward.

Hair Thinning

Using one of the methods to reduce chemotherapy-induced hair loss is not usually totally effective. They make work to preserve some of your hair, but not all, resulting in very thin hair. Some people find that they still need hair covers such as a a wig, cap, or scarf to cover their head, and because of this, going through the process of scalp cooling may not be worth the results.

Methods for Preventing Chemotherapy-Induced Hair Loss

There are both mechanical and chemical methods that have been used in an attempt to stop hair loss from chemotherapy.

Scalp Cooling/Ice Caps 

With scalp cooling, ice packs or an ice cap are applied to the scalp while chemotherapy is being given. The theory behind this is to contract blood vessels near the hair follicles so that the chemotherapy drugs do not reach these rapidly dividing cells. Some studies have found this to be effective in reducing hair loss, but it seems to be most effective with certain chemotherapy drugs, and if previous chemotherapy has not been given. According to a 2017 study published in the Journal of the American Medical Association, the use of scalp cooling for women with stage I and stage II breast cancer resulted in less than 50 percent hair loss following the fourth chemotherapy infusion.

In addition to discomfort related to the cold such as a headache and the feeling of coldness, participants have also expressed concern over the increased time and space required to add this method to chemotherapy.

Scalp cooling appears to be most effective when combined with chemotherapy drugs such as anthracyclines such as Adriamycin (doxorubicine), and taxanes, such as Taxol (paclitaxel).

Scalp Compression

Compression headbands have also been used with or without scalp cooling, though alone they are much less effective than scalp cooling. Clinical trials are in progress, primarily looking at the effect of compression headbands for those having radiation therapy to their brain (radiation, in contrast to chemotherapy, often leads to permanent hair loss).

Medications 

Medications have also been used in an attempt to reduce the loss of hair during chemotherapy. It's important to keep in mind that as with any medication, the side effects can be significant, and these should only be used under the careful guidance of a physician.

Medications that have been tested for their ability to reduce chemotherapy-induced alopecia include:

  • Rogaine (minoxidil) topical 2% solution: This medication is perhaps best known as the medication marketed topically to prevent male pattern baldness. While it probably does little to prevent actual hair loss during chemotherapy, it's thought that it may help hair grow back faster after chemotherapy is finished.
  • Panicum miliacum topical: As with Rogaine, this is not particularly helpful in reducing hair loss, but again, is thought by some to aid in hair re-growth later on.

Bottom Line

Choosing to avoid hair loss due to chemotherapy is a very personal decision. There are some people for who these methods are not recommended, such as those with blood-related cancers. For those with solid tumors, issues such as comfort, cost, and only partial prevention of hair loss need to be considered. If you wish to try one of these methods, talk to your oncologist. Many infusion nurses are unfamiliar with methods such as scalp cooling, and you could be essentially on your own to make sure it is done correctly and that you have all of the necessary equipment.

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