Given the choice between life and death – treating a serious illness versus doing nothing – the answer is clear.
Yet quality of life is an important concern, and some patients may not be willing to undergo a debilitating treatment for the chance of extra time.
For people with cancer, chemotherapy that can save their lives can also lead to extensive hair loss – and research suggests that 8 percent, one in 12, refuse or postpone potentially life-saving treatment because of the psychological stress of losing their hair.
“Hair loss is a source of huge disagreement and fear because it is a constant and public reminder that people are seriously ill,” says Professor Justin Stebbing, consultant oncologist at NHS Trust, Imperial College Healthcare.
People often don’t talk about it, which is one of the reasons that a recent episode of Cold Feet, which featured the character played by actress Fay Ripley, removed her wig to reveal the thinning hair caused by chemotherapy, both from fans and from charities for cancer
“I had patients refuse therapy because of this fear – with devastating consequences. But for some people, quantity of life is not good without quality, and hair loss is central. “
“Certainly if I explain the side effects of chemotherapy, patients break down,” says Professor Robert Thomas, consultant oncologist at Bedford and Addenbrooke’s hospitals. “Patients I have recently seen who have refused the extra benefits of chemo include a teacher and a police officer because they would not like to go to work if they had lost their hair. It can destroy lives. “
The consequences of hair loss are so great that it causes 5 to 10 percent of patients serious psychological injury, adds professor Karol Sikora, a consultant oncologist in London.
He, too, had patients refused life-saving cancer treatment for this reason: “I currently have a patient I cannot convince and yet her chances of survival are much poorer without it,” he says.
For people with cancer, chemotherapy that can save their lives can also lead to extensive hair loss – and research suggests that 8 percent, one in 12, refuse or postpone potentially life-saving treatment because of the psychological stress of losing their hair (file image )
In the UK alone, around 300,000 patients receive cancer chemotherapy.
According to research by Professor Diana Harcourt, director of the Center for Appearance Research at the University of West England, the “vast majority” were concerned about losing her.
“It’s another way in which diagnosis and treatment are not under control,” she says. ‘It can make people so self-aware that they stop socializing and their quality of life deteriorates. Some patients told us that they slept in their wigs or got up early so that their partners did not see their bald heads. “
People often avoid talking about it, which is a reason for a recent episode of Cold Feet, in which the character played by actress Fay Ripley removed her wig to reveal the thinning hair caused by chemotherapy, both among fans and at cancer charities was won.
DO DO DOCTORS ENOUGH?
Yet there can be disagreement between doctors who focus on killing cancer and patients who think more about how they will feel or look, “says Prof. Thomas.
Prof. Sikora agrees: ‘Hair loss can be one of the most depressing features of cancer, but doctors are still learning about the true impact it can have – and are adapting their approach.
“There are other drugs that we can offer that do not cause hair loss, or we can adjust the regime with lower doses, but these are usually weaker against the cancer. If I had my way, I would convince patients every time that the benefits of a treatment far outweigh the risks; but it is more challenging than that and I am learning to become better at counseling. “
There can be disagreement between doctors who focus on killing the cancer and patients who think more about how they will feel or look ‘(file image)
In some cases, the side-effect of hair loss may have been trivialized: in the US, patients have filed claims against pharmaceutical company Sanofi for lack of a warning of the risk of permanent hair loss with the drug Taxotere (docetaxel).
“This is a widely used drug that we prescribe for breast cancer,” says Prof. Sikora. ‘The concern here is that about 5 percent of women experience permanent hair loss after use, which is disastrous. There has been some question as to whether Sanofi knew this was the case and did not warn patients or doctors. “
NEW WAYS TO STOP HAIR LOSS
Not all types of chemotherapy cause hair loss, although the types that are often used for breast and prostate cancer. Researchers try to understand why hair loss occurs and how to prevent it.
Chemotherapy focuses on rapidly dividing cells – this includes tumor cells but also those in the hair follicles (from which a hair grows), nails, skin and intestines (hence chemo can cause nausea).
How cancer stimulated celebrity crimper to help patients
Wigs have come a long way and many now look more natural than ever. However, because this is not a medical problem, the NHS is limited.
To bridge this gap, celebrity hairdresser Trevor Sorbie has been seeing clients with chemotherapy-induced hair loss for more than a decade and offers to cut and style their wigs for free.
“A penny dropped 12 years ago after my sister-in-law lost her hair to chemotherapy,” he says.
“She had a wig, but she was sad that she didn’t look like herself, so I cut it to give her a special feeling.
“Clients tell me that losing hair can be just as devastating as being told that you have cancer. I met four women who refused chemo instead of losing their hair. “Trevor was diagnosed with colon cancer seven months ago and had surgery; then a family member was also diagnosed with cancer, which motivated him to help patients.
“Every specialist – surgeons, nurses, oncologists – has a role, but there are insufficient resources for hair loss at the NHS, so hairdressers fill it in,” he says.
Trevor founded the My New Hair charity to train hairdressers to cut wigs for cancer patients, and has been involved in lobbying MPs to push for better NHS wig services.
Go to mynewhair.org to find a trained hairdresser
For several years, patients have been offered cooling caps – lightweight, silicone caps with liquid coolant – to wear during chemotherapy. “Cold caps work in a combination of ways,” says Dr. Nikolaos Georgopoulos, a cancer cell biologist at the University of Huddersfield. “First, by making the scalp cooler, you limit blood flow, which means that less chemotherapy reaches the hair follicles.
“Second, laboratory studies suggest that cooling hair cells slow down their metabolism and get them out of their normal cell division cycle – so they’re less focused on chemotherapy drugs that work on rapidly dividing cells.
“Third, a study that we want to publish soon has shown that cooling inhibits the transport of the drug into hair follicles, where it would have toxic effects.”
Studies on cold caps show that they have a success rate of 50 percent for retaining hair. Research is now trying to explain why they don’t work for everyone – a reason, Dr. Georgopoulos, it appears that some patients have ‘hot heads’, which means that their scalp does not cool sufficiently.
‘We have followed the temperature of the head with infrared imaging and cooled heads with cold caps. We found a number of heads that had cooled down sufficiently to prevent toxicity – reaching 18c – but others would not fall below 26c. This may be a reason why cool caps don’t work for everyone. “
He now develops better fitting caps and finds ways to cool the scalp more efficiently. ‘For example, we are testing a lotion that contains a natural compound that increases the protective effect of cooling – within five to ten years, this can mean that the chance that you won’t wear a wig is closer to 90 percent; they are currently 50 percent, “he says.
Cool caps are also not recommended for all patients, says Dr. Felicity Paterson, a clinical oncologist consultant at Royal Surrey NHS Foundation Trust. ‘People with head or brain diseases are not suitable for cold caps, because it cools the hair follicles, so that the cells in the area no longer respond to their treatment.
There is also a slightly higher risk of developing brain disease with some aggressive breast cancer. “Research is under way into drug-type approaches to help hair growth. One of the most promising is bimatoprost, originally developed as a glaucoma medicine. Doctors noted eyelash growth as a side effect – and it has been shown to help with alopecia eyelashes in a study of 130 patients, The British Journal of Dermatology reported in 2015.
In the meantime, calcitriol, a form of vitamin D, has been shown to protect rats against chemotherapy-induced alopecia. Research also shows that the use of the drug minoxidil after chemo can halve the time for hair growth. A study of 22 women who had breast cancer chemotherapy found that daily use of minoxidil shortens the time it takes to regrow it, the Journal of the American Academy of Dermatology reported in 1994.
The good news is that most new cancer medicines do not cause hair loss, says Professor Stebbing (file image)
CAN HELP EVENING TREATMENT?
The good news is that most new cancer drugs do not cause hair loss, says Professor Stebbing.
“For example, monoclonal antibody drugs – which target specific proteins on the surface of cancer cells – do not cause hair loss. Neither is immunotherapy, which allows the immune system to recognize and target cancer cells. “
Prof. Sikora adds: “It is possible that most drugs will not cause hair loss within five to ten years.”
Taxane drugs, such as Taxotere, are thought to be associated with permanent hair loss because they damage the stem cells in the follicles that help shape hair.
A laboratory study from the University of Manchester discovered that it was possible to coat follicles with a different type of cancer drug, making them ‘less susceptible’ to the effect of taxanes, the journal EMBO Molecular Medicine reported.
Other researchers have investigated the timing of chemotherapy. A 2013 study by the University of Southern California suggested that treatment in the evening could prevent hair loss.
They discovered that mouse hair had a circadian clock – a 24-hour growth cycle followed by repair – and that mice lost 85 percent of their hair if they received cancer therapy in the morning, compared to a 17 percent loss if they did in the evening, it reported journal Proceedings of the National Academy of Sciences.
“Although we do not yet know whether human hair follows the same clock, [we know] Men’s facial hair grows throughout the day, resulting in the 5-hour proverbial shadow, “said Professor Satchidananda Panda, the lead investigator and an expert on circadian rhythm.
Cancer cells do not have circadian clocks because they share constantly, meaning that cancer therapy does not have to be timed to be more effective – the timing is about minimizing damage to healthy cells such as hair.
NHS WIGS THAT ARE NOT FORMING
For patients with hair loss, the NHS offers compensation for a wig – but this is something of a zip code lottery, Dr. Matthew Harries, a dermatologist consultant at Salford Royal NHS Foundation Trust.
Many patients go private at a cost of £ 70 to thousands. Since most chemotherapy does not harm the stem cells in hair follicles, growth is normally resumed within a few weeks of chemotherapy discontinuation.
However, this hair is often different from the original; many patients experience curling or straightening and the hair is softer, such as baby hair. “I have had patients who had turned gray and their hair grew black or red after chemo,” says Dr. Paterson.
It may take about six months before a full bunch of hair returns, but patients often receive little advice on how to stimulate regrowth, Dr. suggests. Harries.
In addition to medicines, including minoxidil, simple measures such as the use of baby shampoo and no heat or dyes can protect the hair from growing back.
WOMAN WORKING WONDERS ON THE CUTTING EDGE
Natural appearance: Yulia Baynham
The Rolls Royce hair replacement option for chemotherapy patients is offered by Jennifer Effie, a hairdresser in London, who has made it her life’s work to help women who have lost their hair. Not via wigs, but via a ‘hair replacement system’.
The idea is to duplicate what a person’s hair looked like before hair loss – that is, the same color, density and style – for an incredibly natural look.
Jennifer explains: “I take strands of patient hair before they lose it and send it to one of two manufacturers, depending on the hair type: for blond hair it is sent to Russia; darker hair goes to the Philippines. I also send measurements of their head size. There they analyze the density and color to create a long style and send it back, stitched by hand to a tailor-made lace cap. This is then attached to the customer’s scalp with a special glue and styled as desired. “
Customers come back every four weeks to remove the cap, wash the scalp and hair – and then reapply. When the hair grows back, the replacement system becomes a wig that can be pulled on and off while regrowth can continue. About 70 percent of Jennifer’s customers undergo cancer treatment.
“It’s a very satisfying task,” says Jennifer. “I even recently had a man call me to thank me for having his wife back.”
One of them who helped them is Yulia Baynham, 44, a director at a global consulting firm.
Yulia, who lives in West Sussex with husband Mark, head of anti-fraud at a charity, and their teenagers Natasha and Daniel, was diagnosed with breast cancer in January 2019.
“It was the biggest shock of my life. At home, Mark and I sat on the floor in the kitchen and cried a lot. “
She had a 3 cm lump in her chest and underwent double breast amputation and reconstruction after 16 cycles of chemotherapy. This was followed by 25 cycles of radiotherapy.
She suffered from mouth ulcers, sleeping problems, hot flashes. “But the hair loss was the worst,” she says. “In fact there were two phases of the shock: one was the reality of living with cancer, and the other came to terms with what I would look like now.
“I had long, thick blond hair and was proud of my appearance. I was warned about the hair loss, but nothing can really prepare you for the horror.
“I started to wear hats to cover the places where the hair had fallen out in clumps, but I struggled to find something suitable to wear to work with my work dresses.”
Then a colleague recommended the hair replacement system. “It gave me back the confidence that chemotherapy stole,” says Yulia. “The incredible part was that my mother didn’t notice that it wasn’t my real hair when she first saw me. I had hidden my diagnosis from her because she lived abroad and I didn’t want her to worry. I would talk to her every day during a video call and wrap my hair in a towel and pretend I’d finished showering; or wear a headband and say that I went to yoga.
“I only told her when she had been in my chemotherapy for three months. She didn’t know I had a hair replacement system. “
This system is not cheap – it costs around £ 2,000 to buy and £ 85 a month for ‘refreshing’ in the salon. “But I wore it for nearly six months and it’s not far from what I used to spend on salon visits – and it’s definitely worth it.”
For more information about the hair replacement system, visit: jehair.com