We aimed to study characteristics of chemotherapy-induced alopecia (CIA) and recovery during and after chemotherapy for early breast cancer and to evaluate factors associated to permanent alopecia.
Between February and April 2018, we conducted a telephone interview survey of 149 patients who had completed neo/adjuvant chemotherapy for breast cancer since at least 6 months. The questionnaire asked questions about characteristics of hair loss occurrence and regrowth. Clinical and therapeutic data were collected from patient’s records. Permanent alopecia was defined as the absence of complete or partial hair regrowth after 6 months of the end of chemotherapy. Ki2 Pearson test and odd ratio were used to evaluate risk factors.
Median age was 48 years [30-73], 95% received sequential chemotherapy. CIA was seen in 98% of patients (Grade I in 16.1% and Grade II in 83.9%). Initial alopecia occurred during the first cycle in 29.7%, the second cycle in 45.9% and the third cycle in 24.4%. Hair loss was painful in 44.3%. Hair recovery started after a median of 3.15 months. Patients reported a change of hair colour into white in 16.8% and into a different color then before in 21.5%. A change of hair texture was seen in 51% of cases (35.6% softer, 15.4% less soft). Hair regrowth started the same way in all scalp in 77.9% and only one region then the others in 22.1%. Patients used medical/natural treatments in order to reduce hair loss in 24.8%. After a median time since the end of chemotherapy of 2.8 years, incidence of complete permanent alopecia was 1.7% and partial permanent alopecia was 22.1% (total 23.8%). Among all studied factors (Table), patients with permanent alopecia significantly experienced more pain during CIA (60% vs 39%, p = 0.03), with an odds ratio of 2.34.Table: 17P
Evaluation of permanent alopecia possible risk factors using Ki2 Pearson test
|Permanent Alopecia (complete and partial) (23.8%)||Non-permanent Alopecia (76.2%)||p|
|Adjuvant endocrine therapy||69%||57%||0.43|
|More then 3 full pregnancies||39%||40%||0.9|
|Age at diagnosis <40||18%||20%||0.7|
|Age at diagnosis >65||6%||6%||0.8|
|Alopecia since the first cycle||30%||29%||0.9|
|Pain during hair loss||60%||39%||0.03|
|Start hair recovery >6 months of the end of chemotherapy||18%||10%||0.2|
Our study described several aspects of symptoms, chronology and topography of hair loss and regrowth after CT for early breast cancer. Pain during hair loss may reflect a severe stress in hair follicles which may be associated to subsequent hair regrowth issues.
Clinical trial identification
Legal entity responsible for the study
Medical Oncology Department, Abderrahmen Mami Hospital.
Has not received any funding.
All authors have declared no conflicts of interest.