By Michael P. Kosty, MD, FACP

Question:
Why do I lose my hair when I get chemo?
If I don’t‚ does that mean it’s not working?

Answer:
All medicines have side effects. For some patients‚ the most bothersome is hair loss. While a patient can hide a lot of other side effects‚ hair loss can be an everyday reminder of treatment.In general‚ cytotoxic drugs (chemotherapy) work most effectively against rapidly growing cells‚ which include cancer cells‚ blood-making cells‚ cells lining the gastrointestinal tract‚ and cells in the hair follicles.

After a chemotherapeutic drug is administered‚ the drug sets into motion an irreversible chain of events leading to the death of not only the cancer cell but also other rapidly dividing cells.

While most chemotherapy drugs do not stay in the body for a long time‚ their effects (good and bad) can be long lasting. In the same way that some drugs have a more profound effect on blood count‚ different drugs affect hair growth to varying degrees. Some commonly used chemotherapy drugs like 5-FU have little effect on hair‚ while others such as Adriamycin® (doxorubicin) and Cytoxan® (cyclophosphamide) almost universally cause hair loss.

Another factor influencing the likelihood of losing hair is the treatment dose and schedule. Weekly schedules often employ lower individual doses than every-three-week or every-four-week schedules. These lower doses are less likely to cause hair loss‚ low blood counts‚ and other side effects.

A number of things have been tried to prevent hair loss. One of the most popular was an ice cap or cold cap‚ a rubber cap that looked like a swimming cap filled with ice‚ which patients wore while they received chemotherapy. By cooling the scalp‚ there was less blood flow to the hair roots and less exposure to the chemotherapy drug in the blood. Unfortunately‚ for most patients‚ this approach did little to prevent or reduce hair loss‚ and is now rarely used. A number of companies are working on drugs to reduce or prevent hair loss. Like antinausea drugs or drugs that boost white or red blood counts‚ these drugs may someday make chemotherapy-induced hair loss a thing of the past.

Finally‚ for better or worse‚ there is no correlation between chemotherapy side effects and effectiveness.

Send your questions to editor@curetoday.com.