Cancer Care
by Daniel Field

This guide is designed to help support those who have decided to undergo chemotherapy, before during and afterward.

The normal scalp has around 100,000 hairs. Hair growth and fall is a constant cycle. Old hairs fall out because new hair is growing through and push out old ones. This cycle works in a different manner during chemotherapy. Chemotherapy can cause tremendous hair loss. Chemotherapy drugs spread throughout the body in order to destroy cancer cells. Some of these drugs end up in the hair follicles, which may result in hair fall. The effect of this treatment differs from patient to patient. It is quite possible that some people may suffer from hair loss and some may not in spite of taking the same treatment and drugs for cancer.

Many people see their hair as a very important part of their appearance. For some people, losing their hair can cause very strong emotions, such as anger and depression. While you are going through treatment and having to cope with many changes to your life, losing your hair may seem like the final straw. It can also act as a constant reminder that you have cancer and may make you feel vulnerable and exposed. If your eyebrows and eyelashes also fall out this can make you feel even more vulnerable. These reactions are completely normal. It may take a while to come to terms with hair loss.

Which treatments could cause hair loss? 
Chemotherapy
Chemotherapy is a treatment which uses anti-cancer drugs to destroy cancer cells. The drugs work by attacking the cancer cells and disrupting their growth. Unfortunately, they can also affect the normal cells in the body, including the cells of the hair follicles. This can cause hair loss but unlike cancer cells however, the normal cells quickly recover, so if you lose your hair due to chemotherapy it will normally grow back when your treatment is over. Before you start chemotherapy, your doctor or chemotherapy nurse will discuss the possibility of hair loss and other side effects with you. Not all chemotherapy drugs make your hair fall out, and sometimes the loss is so small it is hardly noticeable. Some people, however, have temporary, partial or complete baldness. Some chemotherapy drugs make other body hair fall out, such as eyebrows, eyelashes, underarm, leg and pubic hair. The amount of hair that falls out, if any, depends on the drug or combination of drugs used, the dosage given and the way that your individual body reacts to the drug. If your hair is going to fall out, it usually starts within a few weeks of starting the chemotherapy, although very occasionally it can start within a few days, which can be very shocking.. The first thing you may notice is that your hair starts to come out when you brush, comb or wash it. You may also find hair on your pillow in the morning. For some people their hair may just thin, become dry or break more easily. For other people the hair may carry on falling out over a couple of weeks so that they become completely bald. Sometimes the hair comes out very quickly over 1–2 days, Your scalp may feel tender or sore as the hair falls out but often you will feel nothing.

What you can do to prevent hair loss during chemotherapy

The Cold Cap
By freezing the scalp during chemotherapy it is sometimes possible to reduce the amounts of chemotherapy drugs that reach the hair follicles and in some cases prevents the hair from falling out. It is done by using a 'very cold cap' or a machine which freezes the scalp. There are many different ways of cooling the scalp so the methods used vary from one hospital to another. Some hospitals do not have facilities for scalp freezing. Some commercially made 'cold caps' contain a gel that stays very cold for a long period of time. The caps can be applied easily and kept in place by Velcro. The cap can be uncomfortable though and the extreme cold may give you a headache. However, the chemotherapy staff will do all they can to make you as comfortable as possible. Some types of scalp cooling use a machine (like a commercial hair dryer) that circulates the coolant through the cap.
The cap is put on fifteen minutes before chemotherapy to start restricting blood flow, and kept on during and up to 1-2 hours after your chemotherapy. This does mean that your time in the unit is longer. This discomfort varies from patient to patient so it is not a failure if you can't wear it and it has no influence on the outcome of your cancer treatment. In a clinical trials to date, however, less than 2% of patients who had retained their hair did not continue with the procedure.The 'cold cap' method is effective in preventing hair loss for most chemotherapy drugs. Some individuals however still loose their hair despite using it and some drugs are more likely to cause hair loss than others. The scalp is cooled to a temperature of +17 ^oC to achieve a subcutaneous temperature of +20 ⁰C (68 ^oF) this constricts the blood supply to hair follicles diminishing or abolishing their perfusion hence preventing high chemotherapy dose delivery during the initial phase of chemotherapy. Further, coldness itself reduces the availability of (chemotherapy) cytotoxic drugs to the cells of the hair follicles by directly reducing their metabolic rate. It is the combined effect of both these mechanisms, induced by cooling the scalp, that prevents or reduces hair loss The cold cap system works better for some drugs than others. Also they may not be advisable when treating some types of cancer. Your doctor or chemotherapy nurse will be able to tell you if scalp cooling is available and whether it is appropriate for you. Clinical trials show a success rate of up to 85% with Docetaxel (taxotere), Epirubicin, Cyclophosphamide, Paclitaxel (Taxol) .

What you can to do to make life more bearable if you still loose your hair.

There are many practical ways to help you cope. They won’t make the problem completely disappear but they can make life a little easier for you during this difficult time. At first you may feel reluctant to go out and carry on with your social life, but as you spend more time with other people your confidence should grow and help you to cope with the situation.

Au natural
Having cancer is nothing to be ashamed and raising public awareness by going au natural can be very empowering for some but many people really do want to divert attention from their hair loss so this may not be a palatable option for you..

To cut or not to cut
If you have been told you are going to loose all your hair regardless, rather than letting it fall out on it's own you could consider either shaving your hair off or cutting it very short before the actual treatment commences. This may help lessen the trauma of the eventual loss not to say the mess around the house. If you are used to very long hair you might find it easier to have it cut in stages to give you time to adjust. This can give you some sense of control over what is going to happen. Some people may not want to cut their hair for cultural or religious reasons, and may find alternative head wear can be helpful right from the start to limit the emotional effects and the stress your hair fall may cause family members.

Wigs
You might want to buy a wig before treatment begins or at the very start of treatment whilst you still have hair. If you do so remember to check first the wig can be adjusted smaller as you lose the hair. The benefit is they can better match your hair color and texture. Or you can keep a swatch of fallen hair from the top front of your head to use for matching and why not take a good quality photograph now for future reference? Be sure to get a prescription from your doctor for the wig because the NHS has a scheme of sorts. Get a list of wig shops in your area from your doctor nurse or other patients. If you are going to buy a wig, try on different ones until you find one that you really like. Synthetic wigs require less styling than human hair wigs. They may be easier to care for if you have low energy during cancer treatment and as they are far less expensive consider buying 2 wigs, one for everyday and one for special occasions. I find so many people actually enjoy trying different styles, colours and lengths that they have been able to actually enjoy this aspect!

Turbans scarves and hats
Some people don't enjoy wearing wigs at all. In that case, turbans or scarves can be used instead of wigs. Cotton items tend to stay on your smooth scalp better than nylon or polyester and are less hot. There are also companies making specialised head coverings for chemo patients, even special hats with hair sown in to appear natural..What ever you decide on, wear something on your head outdoors in cold weather to reduce the loss of body heat and always use sunscreen, sunblock, or a hat to protect your exposed scalp from the sun.

Highlighting other features.
For women, wearing a little extra make-up around your eyes, cheekbones or lips will help to direct attention to your face.. Some hospitals and support groups run programs such as Look Good-Feel Better and Head Strong. Both programs give expert advice on make-up and skin care. Your nurses can let you know if there is a program like this in your hospital or at a nearby support group. Eyelashes and eye brows can fall out but eyebrow pencil and false eyelashes provide simple solutions. I make especially pure, toxin and low irritant hair and skin care products designed to be used before, during and after chemotherapy treatment.

Change the focus
Necklaces and chains emphasise your neckline while earrings look good with hats and scarves, Brightly coloured shirts, sweaters, ties or tops all draw attention away from your hair.

Hair, Scalp and Skin Care both during and after cancer treatments
Whether or not your hair falls out as a result of cancer treatment, it can make your hair, scalp, skin drier and more delicate. I produce special products for hair, skin and scalp care. These products will significantly help you between and after cancer treatments. For those undergoing chemotherapy, the drugs used are cytotoxic and my products have been formulated to help remove cytotoxic drugs from both the skin and the scalp. Radiation can burn the skin and cause inflammation, so skin and scalp care products that help reduce this inflammation can be very helpful. Your hair may begin to grow back before you finish your treatment or afterward. When your hair first grows back it will be very fine but will gradually become thicker. As soon as it is long enough to style, you may feel that you no longer want to wear a wig or other head covering. People who were used to long hair often find this shorter style actually suits them. You will probably have a full head of very short hair after 3–6 months. You may find that this first crop of new hair is curlier or finer than it was before. It may also be a slightly different colour, or sometimes a mixture of dark and grey hair. When this new hair starts to grow, it may break off more easily at first. Avoid perms for the first few months. It will be far easier to style if you keep this new hair trimmed in the early growth phase. It needs to be allowed to get thicker before it can provide you with length that will look healthy and well groomed. Very rarely, after high doses of chemotherapy the hair does not grow back well if at all on it's own accord. This is very unusual but please contact me, Daniel Field directly, should this appear to be the case. I may be able help.

How to look after your hair with Daniel Field's Amara products.

Cleansing the hair- When your hair starts to grow back the scalp can also become scaly. This dryness is due to the toxins in the treatment coming out through the scalp but these can be removed faster from the follicles with one of our special Amara Daniel Field shampoos. Apart from helping speed up the removal of toxins these are also free of toxins, known common allergens and all known skin irritants. It is best to avoid 'normal' shampoos which may contain Sodium Laureth Sulphate as these can irritate the scalp further. In any event the first growth of new hair is either brittle or delicate, courser or far wispier. You will need less powerful cleansing and Amara will take you safely through your future hair care needs.

Conditioning the hair Amara by Daniel Field has two conditioners Hydrating Conditioner for courser drier hair and Revitalising Conditioner for softer wispier hair that tends to go flat too easily..Both are ideal if you have or are undergoing chemo or radiation treatments.

Hair and scalp treatments- More often than not post chemotherapy patients find their scalp can be drier and their hair texture and condition totally different from before treatment for the first six months at least. I make a few special hair treatments designed for this 'new hair' texture as well as special scalp treatments designed to help remove post chemo toxic build up from the follicles. Hair does grow back faster and stronger with this extra support however in time the body will reject the chemo cytotoxins, expelling them through the lymph and sebaceous glands enabling healthy growth to ensue once again.

Styling wispy hair Post chemo hair can be finer and wispier and may look a bit odd at first. The hair can benefit from a special hair thickener designed by Daniel Field for this very problem. Amara Total Thickener by Daniel Field is made from protein polymers and will widen each single hair strand by around 25% instantly whilst keeping the silky texture adding style control.

Styling various types of frizzy hair- Post chemo hair can be over-course or over-soft and often is frizzy for a while and if you are still on cytotoxic drugs will tend to also grow in every direction like a bad perm. I produce a number of smoothing products for these various textures. These will not cause the hair to become oily or heavy just super smooth and silky.

Daniel Field's Kebelo Smoothing System- Once the hair is over three inches long, it is quite possible without the use of any toxic or harsh chemicals to restructure the hair entirely. This will cause the hair to become straighter, significantly smoother and unbelievably glossy. With the body remaining at the roots it then requires no real maintenance at all. A permanent blow dry if you like that lasts around 100 days. Sounds impossible but we use this system on all unmanageable hair types in the salon. It actually aids healthy regrowth for those post chemo. takes 2 hours in the salon and costs around £250 including 100 days aftercare.

Super safe and gentle colouring 

Once your hair has grown enough you may want to colour it. Do not perm it until the hair has regained it's original strength though. Most post chemo hair is quite a lot greyer than before so when you want to colour your hair. If you prefer your hair lighter you will need my Organic and Mineral Hair Colour or if you just want to add colour to grey or darken the original hair use my Water Colour. Both are permanent and were created by me, Daniel Field and are considered totally safe for chemo and post chemo patients as well as those who have had radiation treatment.

 Modern hair dyes are quite unlikely to increase the risk of cancer.
Many studies, including recent analysis, show that modern hair dyes are not linked to leukaemia, lymphomas or bladder cancer. In the 1970s some hair dye ingredients were found to damage DNA and cause cancer in animals. Then hair dyes could contain small amounts of chemicals called arylamines. Arylamines may have capable of producing cancerous cells but most of us have genes that render these harmless. A small minority of people may have different versions of these genes, which may not be as good at processing arylamines. These people had a slight increased risk of bladder cancer if they used hair dyes regularly before the 1980's. Since then, the use of all suspect chemicals has been discontinued and modern dyes are thought to be safe.

Long Hair Preferences

Those people who don't like to wear their hair short will keep their wig on until it gets too tight. After that they can buy a larger size or obtain the appearance of thicker and/or or longer hair using one of these methods;

At Daniel Field we provide clip on hair extensions. These add instant thickness and/or length I prefer clip on hair extensions once there is four or five inches of hair growth post chemo as they are far gentler and less expensive than these other solutions below

Bonded Hair Extensions involve bonding natural hair with glue to the roots of existing hair. This is not suitable for people after chemotherapy on all but the strongest hair. Post chemo hair is weak and this process stresses existing hair and may make it fall out in patches.

Hair Weaving is a way of adding hair to the scalp by weaving or braiding in extra human or synthetic hair. The hair is woven into the root area of your hair so that it grows naturally with the hair. It is best to avoid hair weaving for a few months after chemotherapy and if you are taking medicines that weaken the hair, such as hormonal therapies or biological therapies.

Adding a Hair Bespoke Piece
If you have patches of hair that will not grow back (for example, after radiotherapy), there are number of solutions. The most popular is a simple hair piece, made to measure which is undetectable. I can organise all this for you. The hair is mixed to the perfect colour match and cut to blend in with your regular style. It can be removed at night and is simple to maintain. The procedure will take two visits. One for the exact scalp template fitting lasting 30 minutes and one with me for the cutting.

©Daniel Field Ltd 2011