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Cancer treatment and hair loss

Hair loss can be a side effect of cancer treatment. Not all cancer treatment causes hair loss. 

Any treatment which acts on rapidly dividing cancer cells can also affect other rapidly dividing cells such as hair follicles (roots). Talk to your doctors and nurses before treatment starts about whether you are likely to lose your hair, and if so, the level of hair loss to be expected.

Chemotherapy is the use of drugs to reduce or stop the abnormal growth of cancer cells. Depending on what type of chemotherapy you receive you may experience complete hair loss, hair thinning or no impact on your hair at all. Chemotherapy drugs are usually given in cycles and the amount of hair loss depends on the type of drug, the dose and the timing of treatment.

Hair loss can occur anywhere on the body including the scalp, eyebrows, eyelashes, chest, underarms, face and pubic area.

Chemotherapy may cause the hair on your head to break off at or near the scalp. Shortly before the hair falls out you might feel some scalp irritation, discomfort or itchiness. You may notice fallen hair on your pillow and sheets and when you brush or wash it. The hair may fall out over a very short period of time (days). It is common for hair loss to begin two to three weeks after starting treatment. Eyelashes and eyebrows may take longer to fall out.

Cold caps

Cold caps or scalp cooling may help reduce the amount of hair loss for some individuals. They work by narrowing the blood vessels and reducing the amount of chemotherapy reaching the scalp. Not all treatment centres offer these as they can be expensive and are not always successful. Scalp cooling is not suitable for everyone so you will need to check with your health professional.

Download our booklet ‘Understanding Chemotherapy’

Also known as radiotherapy, radiation therapy uses a controlled dose of radiation to kill cancer cells or damage them so they cannot grow, multiply or spread. If you have hair in the area being treated, you may lose some or all of it during or just after radiation therapy. Hair regrowth or thickening may start within a few weeks of finishing treatment, but sometimes hair loss may be permanent.

Hair will only fall out in the area of the body being treated. For example, if you are having radiation therapy to your head you will probably lose some hair from your scalp. If the area being treated includes an armpit or your chest, then it is only hair in these regions that is likely to fall out.

Download our booklet ‘Understanding Radiation Therapy’

Managing hair loss

If you have hair loss, you may experience a range of different emotions including anger, anxiety and acceptance. Some people may feel self-conscious about their appearance and other people find that it is not as bad as they expected. Experiencing a variety of feelings and reactions is very common.

Some people don’t know how to react to your hair loss. If you are uncomfortable talking about it, give a simple response, for example “I’m having some treatment for my health and this is the side effect.” You may also want to help children if they have feelings of fear or anxiety. See the booklet below for tips on how to talk to children about the changes cancer treatment may cause, including hair loss.

Download our booklet ‘Talking to Kids About Cancer’

Being prepared, talking about how you feel and planning ahead for how to deal with the possibility of treatment-related hair loss may be helpful.

  • Consider cutting your hair before treatment starts to give yourself time to adjust. Some people cut their hair short, while others prefer to cut their hair in stages.
  • Some people choose to shave their head at the early stages of hair loss when they start to notice larger amounts of hair falling out.

If you have lost your hair:

  • gentle massage and moisturising of the scalp using a non-perfumed lotion or emollient can help reduce flaky areas
  • protect your scalp from the sun with sunscreen, a scarf or hat
  • use a pillow case made from a smooth fabric such as polycotton, cotton sateen or bamboo
  • you may like to wear a soft cap, beanie or turban to keep your head warm.

If your scalp is sensitive and your hair is thin:

  • use a gentle shampoo and conditioner
  • brush your hair gently with a soft bristle brush
  • dry your hair naturally or use a cool setting on the hair dryer
  • avoid heated rollers, curling wands or straightening irons
  • avoid harsh chemicals such as hair colouring, gel, mousse and perming agent.

If you have lost underarm hair avoid perfumed deodorants.

Some people choose to wear a wig, hat, scarf, turban or beanie after losing their hair; others prefer not to cover their head at all. The important thing is to do whatever makes you feel comfortable and gives you the most confidence.

  • A beanie, soft cap or turban is often a comfortable choice; a wide brimmed hat offers more sun protection.
  • Scarves usually need to be at least 50 cm long to cover the scalp. Cotton, lightweight wools or blends are the best fabrics to use, as nylon or silk tend to slip off the head too easily.
  • Scarves and turbans can be styled in many different ways. You may want to search the internet for tips and tutorial videos on wigs to suit your face shape and how to style headwear.

Types of wigs and hairpieces

  • Human hair wigs or hairpieces – tend to be more expensive, need to be washed and can be styled like normal hair with hot rollers, curling wands and straighteners. They can be trimmed and coloured darker but not lighter, are heavier and will last longer.
  • Synthetic wigs or hairpieces – are less expensive, lighter, dry quickly and need less care. They can’t be restyled or recoloured but they can be trimmed. If you look after a synthetic wig it will last for as long as you may need it.

Selecting a wig

  • If you want to match your wig to your usual colour and style, it’s a good idea to start looking before treatment starts and hair loss begins or take along a photo from before hair loss began. Some people like to try something different and choose a different style and colour.
  • Take a friend or family member along with you for support and to help you choose your wig.
  • Ask your hairdresser or speak to a consultant at a wig salon about a style of wig that would suit you. There may be a cost involved for a wig consultation.  Remember to ask about the cost when making an appointment or before making your decision.
  • Look for a wig that adjusts to any head size to allow for variations as you lose your hair. Some people choose a wig after hair loss as this can often provide a better fit.
  • Visit specialty wig suppliers who are experienced in fitting wigs for people having cancer treatment.
  • Contact Cancer Council 13 11 20 or search our local support directory for suppliers near you.

Paying for a wig or hairpiece

You may be able to get assistance with the cost of your wig or hairpiece.

  • Treatment in a public hospital – you may be eligible for financial assistance towards the purchase of a wig. Ask your nurse or social worker for information.
  • Health insurance funds – some funds will cover part of the cost of a wig if you lose your hair due to disease or treatment. You will need a letter from your doctor to accompany a claim. Before you buy your wig, check what your fund will pay.
  • Department of Veterans’ Affairs – veterans may be eligible to have the cost of a wig covered.

Look Good Feel Better is a national community service program run by the Cancer Patients Foundation, dedicated to teaching cancer patients how to manage the appearance-related side-effects caused by cancer treatment. Women, men and teens participate in practical workshop demonstrations covering skin care, make-up and head wear. Look Good Feel Better workshops are held regularly in metropolitan and some regional areas.

Visit Look Good Feel Better or call 1800 650 960 for more information or to register for a free workshop. The website also has practical tips in caring for your appearance.

After treatment

Hair loss is usually temporary. Talk to your doctor about what to expect after your treatment.

After chemotherapy your hair will grow back. Often the first soft hairs reappear within a month or six weeks of treatment ending. Hair usually grows about 1cm every 28 days. You can expect to have a reasonable head of hair four to 12 months later.

When you finish radiation therapy your hair will usually grow back. The time it takes and the way it grows back depends on the dose of radiation you received. Hair usually grows back a few months after treatment. Occasionally after a large dose of radiation therapy the hair may not recover completely, new growth can be patchy and there may be some permanent hair loss.

As your hair grows back you may notice some changes. It may be curlier, thicker or finer than it was before treatment or it may grow back a different colour. A hairdresser may be able to help you manage thinning hair and hair care during regrowth. If your hair loss is partial, talk to your hairdresser about different styling to give the appearance of thicker hair. Hairpieces can be effective in covering partial hair loss.

Seek advice from a professional about how soon after treatment you can colour your regrown hair and the colours or products that may be suitable for you. If your scalp is sensitive, your hairdresser may be able to recommend henna or vegetable-based dyes that may be gentler on the hair and scalp than chemical hair treatments.

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This information was last reviewed August 2019 by the following expert content reviewers: Caitriona Nienaber, 13 11 20 Consultant, Cancer Council WA; Hayley Tuck, Clinical Health Professional, Regional Cancer Support Coordinator, Cancer Council WA; Jacqui Campbell, Nurse Manager – ICON Cancer Centre Hobart; Karen Richardson, Cancer Nurse, Regional Support Services, Cancer Council WA; Marion Bamblett, Nurse Unit Manager, Fiona Stanley Hospital WA; Molly Colussa, Coordinator Practical Support Programs, Cancer Council Victoria; Moira Waters, McGrath Breast Care Nurse, Breast Cancer Care WA; Natasha Girvan, Program Manager, Look Good Feel Better, WA & SA; Rosie
Brown, Cancer Nurse, Breast Cancer Network Australia; Nina Mastrangelo, Consumer SA; Tania Ward, Consumer WA.