Chemotherapy Type and Sequence Can Impact Hair Retention in Breast Cancer


Dr. Julia Rani Nangia explains how certain chemotherapy types and sequencing have different impacts on hair retention for patients with breast cancer.

While chemotherapy causes hair loss in many patients with cancer, particularly in the treatment of breast cancer, the type and sequence of chemotherapies used can have an impact on the amount of hair lost when scalp cooling systems are also used for hair preservation, said Dr. Julie Rani Nangia.

Nangia explained that not only does the fit of a cold cap help prevent hair loss during treatment, but that the order in which certain chemotherapies are given also matter, as the results of two large studies examining the use of cold caps and chemotherapy have found.


CURE®: What percentage of hair do people keep when they use the system?

Nangia: That number really varies. In our study, with all types of breast cancer, the hair retention rate was 50%. And what we saw is that it really depends on two big factors. One is the fit of the cap, and two is the type of chemotherapy.

There are certain chemotherapies, like there's a chemo called Paclitaxel, that's usually given on a weekly basis. With that chemotherapy in both of the big US clinical trials, the hair retention rate was 100%. And we define hair retention by losing less than 50% of your hair and not needing a wig. So, people did have hair thinning but they didn't feel like they needed a wig and when they went out in public, they felt normal.

Now there is a chemotherapy called anthracycline, so these are drugs like Adriamycin, and in our study the hair retention rate was around 20% with that drug, but there were a couple studies that came out after, and this is why I say the order (of chemotherapy) matters. Showing that if you sequence to a drug like Paclitaxel, prior to the anthracycline, that the hair retention rate was closer to 40%. The thought among the people in the field, including me, is what happens is when you wear that cap for 12 times, like you would with Paclitaxel, and it's more effective with that chemo, that you get really good at using it. You get better at fitting it, and there's less gaps, and I really do think that it has to do with the fit.

And so, when I am giving chemotherapy to patients, and I'm a breast cancer specialist, I do use the group of drugs called taxanes, which includes Paclitaxel first, and then I use the drugs of anthracyclines second, and I have noticed significant improvements in hair retention rates. I've had a had a few patients who, even when they lost hair, they kept using it, even though they needed a wig.

Anecdotally, we've seen in our practice that you see hair regrowth faster. And there was a Japanese study that was presented at the San Antonio Breast Cancer Conference last year, which showed that women had their hair growing much faster and much quicker if they use these devices after completion of chemotherapy.

So, if you're sequencing the chemotherapy, so these will be patients that would already be scheduled to get both of those different kinds of chemotherapy…

(In therapy) the order doesn't really matter. But a lot of people are just kind of stuck in their routines and ways, so a lot of practices give the anthracycline first, and there's not really a medical reason to have to use that sequence.

Related Videos
Image of Kristen Dahlgren at Extraordinary Healer.
Jessica McDade, B.S.N., RN, OCN, in an interview with CURE
Image of a woman with short blonde hair wearing a white blazer.
For patients with cancer, the ongoing chemotherapy shortage may cause some anxiety as they wonder how they will receive their drugs. However, measuring drugs “down to the minutiae of the milligrams” helped patients receive the drugs they needed, said Alison Tray. Tray is an advanced oncology certified nurse practitioner and current vice president of ambulatory operations at Rutgers Cancer Institute in New Jersey.  If patients are concerned about getting their cancer drugs, Tray noted that having “an open conversation” between patients and providers is key.  “As a provider and a nurse myself, having that conversation, that reassurance and sharing the information is a two-way conversation,” she said. “So just knowing that we're taking care of you, we're going to make sure that you receive the care that you need is the key takeaway.” In June 2023, many patients were unable to receive certain chemotherapy drugs, such as carboplatin and cisplatin because of an ongoing shortage. By October 2023, experts saw an improvement, although the “ongoing crisis” remained.  READ MORE: Patients With Lung Cancer Face Unmet Needs During Drug Shortages “We’re really proud of the work that we could do and achieve that through a critical drug shortage,” Tray said. “None of our patients missed a dose of chemotherapy and we were able to provide that for them.” Tray sat down with CURE® during the 49th Annual Oncology Nursing Society Annual Congress to discuss the ongoing chemo shortage and how patients and care teams approached these challenges. Transcript: Particularly at Hartford HealthCare, when we established this infrastructure, our goal was to make sure that every patient would get the treatment that they need and require, utilizing the data that we have from ASCO guidelines to ensure that we're getting the optimal high-quality standard of care in a timely fashion that we didn't have to delay therapies. So, we were able to do that by going down to the minutiae of the milligrams on hand, particularly when we had a lot of critical drug shortages. So it was really creating that process to really ensure that every patient would get the treatment that they needed. For more news on cancer updates, research and education, don’t forget to subscribe to CURE®’s newsletters here.
Image of a woman with black hair.
Image of a woman with brown shoulder-length hair in front of a gray background that says CURE.