Permanent Chemotherapy-Induced Alopecia in Patients with Breast Cancer: A 3-Year Prospective Cohort Study

Abstract

Background: Although chemotherapy-induced alopecia (CIA) is considered temporary, some patients report persistent alopecia several years after chemotherapy. There is, however, a paucity of long-term prospective data on the incidence and impact of permanent CIA (PCIA). The objective of our study was to estimate the long-term incidence of PCIA in a cohort of patients with breast cancer whose hair volume and density were measured prior to chemotherapy and who were followed for 3 years after chemotherapy.

Materials and methods: Prospective cohort study of consecutive patients ≥18 years of age with postoperative diagnosis of stage I-III breast cancer expected to receive adjuvant chemotherapy at the outpatient breast cancer clinic at the Samsung Medical Center in Seoul, Korea, from February 2012 to July 2013 (n = 61). Objective hair density and thickness were measured using a noninvasive bioengineering device.

Results: The proportion of participants who had PCIA at 6 months and 3 years was 39.5% and 42.3%, respectively. PCIA was characterized in most patients by incomplete hair regrowth. Patients who received a taxane-based regimen were more likely to experience PCIA compared with patients with other types of chemotherapy. At a 3-year follow-up, hair thinning was the most common problem reported by study participants (75.0%), followed by reduced hair volume (53.9%), hair loss (34.6%), and gray hair (34.6%).

Conclusion: PCIA is a common adverse event of breast cancer adjuvant cytotoxic chemotherapy. Clinicians should be aware of this distressing adverse event and develop supportive care strategies to counsel patients and minimize its impact on quality of life.

Implications for practice: Knowledge of permanent chemotherapy-induced alopecia, an under-reported adverse event, should lead to optimized pretherapy counseling, anticipatory coping techniques, and potential therapeutic strategies for this sequela of treatment.

Keywords: Alopecia; Breast neoplasm; Chemotherapy; Cohort.

Figure 1.

Incidence of PCIA at 6 months and 3 years after completion of chemotherapy. Abbreviations: m, months; PCIA, permanent chemotherapy‐induced alopecia; y, years.

Figure 2.

Average hair density (A, B) and thickness (C, D) during follow‐up. Abbreviations: AC, doxorubicin, cyclophosphamide; FAC, fluorouracil, doxorubicin, cyclophosphamide; T1, before chemotherapy; T2, after two cycles of chemotherapy; T3, 1 month after completion of chemotherapy; T4, 3 months after completion of chemotherapy; T5, 6 months after completion of chemotherapy; T6, 3 years after completion of chemotherapy.

Figure 3.

Representative photographs of a patient's mid‐frontal hair before chemotherapy and 3 years after completion of chemotherapy. (A): ×15. (B): ×60.