Coping with Hair Loss After Chemotherapy

In the United States, hair and beauty are multibillion-dollar industries, with the average woman spending about $50,000 on her hair over a lifetime. Clearly, good hair days are important and for most women, play a strong role in personal identity, self-confidence and the image presented to the world.

So when patients begin treatment for cancer, the concern over hair loss sits front and center on the list of side effects that are likely to become an important part of their experience.

In December 2013, Judy, a mother of three and a busy attorney in her mid-50s, learned that her medical treatment for invasive lobular breast cancer would include chemotherapy. Her doctor did not mince words: among the other side effects of chemo, she would likely experience total hair loss of the scalp. She was healing at the time from a mastectomy and coping with pain, so the news of hair loss came at a time when she was already wrestling with an array of physical and emotional assaults.

Judy recalls steeling herself to the news of impending hair loss with the knowledge that the chemotherapy would be tackling cancer cells in her body. “I knew that my hair would return,” she says. “But in truth, the trauma of hair loss can equal or exceed many of the challenges cancer patients face. It is the visible manifestation of cancer treatment and affects one’s sense of personal beauty and image.”

She underwent her first infusion and waited. Hair loss is not always immediate and can take up to three weeks to begin. In the meantime, at the advice of a trusted hairdresser whom she had consulted, she cut her long hair short, to help her through the process.

Over time, as her hair remained undisturbed on her head, Judy remembers entertaining a fantasy that she might escape the predicted baldness. Finally, after about three weeks, her scalp began to tingle, intensely and uncomfortably, disturbing her sleep. She started to wake up with fine hairs distributed on her pillow — and announced to everyone that she was shedding, like her collie. She would run her fingers through her hair, and lots of strands would come out. It was time for the next step.

Many women turn to wigs during their time of hair loss. Before she lost her hair, Judy wrestled with what would work best for her life. From the outset she says she was convinced that it would be essential to buy a wig because she was planning to return to work and felt, at the time, it might be more comfortable for her clients and colleagues. With the support of friends, Judy turned an emotionally trying task into an adventure. “It is a day I remember mostly because of the love my friends shared with me. We tried on silly wigs and took photos of each of us as a sexy blonde. I selected a very expensive wig very quickly — really, too quickly — and it required a cut, so there was no returning it. By the time I came home, I had named the wig — she was to be “Sabrina,” after the fun-loving, mischievous, sexy witch cousin of Samantha on the old television show Bewitched."

But ultimately, the wig process caused her much more distress than she had anticipated. “Unfortunately, over time, I simply could not make peace with Sabrina and, even with additional trimming and shaping, found that she brought me to tears — some of the most frustrating tears I shed during my entire process dealing with cancer. I think the challenge of dealing with my hair was a metaphor for the rest of my experience and it was in this arena, I allowed myself to cry.”

During recovery, Judy discovered that wearing a few simple scarves work better for her. She wore caps at home — especially during the night when her hairless head could be very cold. “Friends knit caps for me and even if they didn’t quite fit, they gave me great comfort,” she says. When she did return to work, she took one more stab at finding a wig and attended a class called “Look Good, Feel Better”. In addition to distributing bags of high quality donated cosmetics, matched to each woman’s color type, the aestheticians running the class discussed how to apply make-up as well as using scarves and buying wigs. Judy recalls viewing a film featuring Stacey London (television host of What Not to Wear) who advised that wearing jewel tones work best for most women undergoing chemotherapy. “That session was meaningful in practical ways and emotionally uplifting, and we all left looking far better than when we had entered the room,” she recalls.

Lessons Learned

Plan ahead: “I worried a lot about my daughters and believed that my hair loss was particularly painful for them.  Even when I was lighthearted about it and thought they could handle it, I soon realized that seeing me without hair was a greater burden than they needed to carry. So it was helpful to plan for this."

Use humor whenever possible: “I used humor as best I could, which helped me. I came up with imagery that helped me talk about it lightly: like shedding hair, and sporting a Buddha hairstyle, and wearing “kerchiefs” like our mothers used to. My friends handled it so ably, with humor, too, though I know it pained them.”

Take your time: “I am glad that I cut my hair early and was prepared with a plan for shaving my head.  Beyond that, in hindsight, since I was not returning to work with any speed, I would have waited longer after my hair loss to decide what would truly make me comfortable, because there is no one way to handle hair loss. If you can, take your time. I discovered that I didn’t mind wearing simple scarves in my day to day life. Had I waited it out a bit, I might have subjected myself to much less stress than I needed to.”