Cancer itself can be devastating, but it's not uncommon to hear that the side effects of chemotherapy can be more physically and emotionally distressing. Complete loss of hair (including hair on the scalp, arms, legs, pubic hair, eyebrows, and eyelashes) is called alopecia and is unfortunately associated in the US with cancer and disease. Taxotere causes significant hair loss of this type in almost all patients taking the drug. This public display of baldness can be very painful due to the social stigma surrounding cancer and the disease. Patients suffering from alopecia often lament that in public they are seen first as cancer patients and second as people with unique abilities, goals and personalities.
Hair loss associated with Taxotere is particularly concerning because it can be permanent. Unlike most other cancer drugs, 3-15% of people taking Taxotere will experience some level of permanent hair loss. This can range from complete baldness to patchy and inconsistent hair growth.
Why does chemotherapy cause hair loss?
Most chemotherapy drugs work by attacking cell division within the body. Tumors are masses of cancer cells that grow and divide without control. Your naturally programmed cell death has been disabled. To combat this proliferation, chemotherapy drugs target cell division or DNA replication (the first step in cell division).
Unfortunately, chemotherapy drugs don't just target cancer cells. There is no way for the active compounds within the drug to distinguish between healthy cells and the aggressive cells that are making a cancer patient sick. Because of this, all rapidly dividing cells within the body are particularly affected by chemotherapy treatments such as Taxotere. Hair follicle cells are some of the fastest growing cells in the body and therefore are attacked by chemotherapy treatment. Hair follicles can usually repair themselves after chemotherapy treatment is stopped and grow back normally, but sometimes Taxotere can permanently damage the follicles so that they never grow back.
Psychological effects of hair loss
For better or for worse, in our society, hair is part of how many people identify and value themselves, especially women. We recognize people by their hair, and hundreds of thousands of products are manufactured and marketed to perfect that specific physical attribute. However, some patients and their loved ones are surprised at the intense emotional effect that hair loss can have.
Chemotherapy and short-term hair loss
There are some studies that discuss and evaluate people's emotional response to chemotherapy-induced hair loss. For many years, doctors and psychologists have studied how surgery associated with cancer affects body image, but it is only recently that the psychological effects of hair loss have received the attention they deserve. In 1997, one of the first quantitative studies to address this issue was published in Supportive Care in Cancer.
This study followed 29 women who were undergoing chemotherapy treatment for ovarian cancer and all suffered the side effect of alopecia. They were not taking Taxotere, and in all cases, their hair started to grow back after the chemotherapy cycles ended. The study had several components. Each woman was tested for problem-solving ability, general self-esteem, health status and physical condition before starting the alopecia-inducing treatment and after her hair began to grow back. Hethe researchers foundthat "73.3% of patients did not feel as sure of themselves as before treatment and that for 46.6% alopecia was the most traumatic side effect of chemotherapy." This study is particularly important because it shows that even when hair starts to grow back, the trauma of hair loss can have a permanent effect on a patient's self-esteem. When hair never grows back, this damage is likely to be even more serious.
Another study that may be helpful in understanding the emotional effects of hair loss was published in 2007 in the European Journal of Oncology Nursing. This group of researchers focused on how patients prepare for hair loss during breast cancer chemotherapy treatments. they interviewed19 womenwho were about to undergo treatment to talk about how they faced their hair loss. Responses varied, but there were clear traces of fear and dread associated with this particular side effect. Some women feared feeling "out" of themselves or unattractive, while others were frustrated that people in their lives saw them as conceited for lamenting their hair loss. Many were concerned that "their hair loss would make them visibly identifiable as people with cancer and that they would subsequently lose their privacy" when going out in public.
Long-term hair loss support groups
Women who have experienced permanent hair loss due to Taxotere often meet online to share stories and support each other. Many are frustrated that they were never told about this possibility, while others feel that lawyers and doctors do not take their suffering and anger seriously. Threads on sites like the American Cancer Society and Breastcancer.org feature conversations between cancer patients, friends, and loved ones dealing with the disappointment and sometimes depression that can accompany this particular side effect. The placeA head of our timepublishes photos of women with chemotherapy-induced alopecia and provides resources for those seeking answers.
Long-term hair loss trauma
To date, no long-term studies have been conducted on the psychological and emotional effects of permanent hair loss caused by administration of the chemotherapy drug Taxotere. However, it is easy to extrapolate from anecdotal data in chat rooms and forums associated with permanent hair loss and studies of short-term hair loss. While losing hair for a few months or a year can have serious long-term emotional consequences, permanent hair loss, especially when patients are told their hair will grow back, can be devastating. One of the ways patients are able to deal with short-term hair loss is by talking about it with their doctors, friends and family before it occurs. They can also mentally prepare by reading about the process and physically by purchasing special wigs, hats, or scarves for comfort and privacy. When patients are deprived of this outlet and the potential effect of long-term hair loss is hidden from them, the side effect can be exponentially more harmful.
Taxotere linked to hair loss
When Taxotere first appeared on the US market, the Food and Drug Administration (FDA) did not mention the possible side effect of permanent hair loss. Several lawsuits allege that the risks were known much earlier, and in both Europe and Canada, drugmaker Sanofi-Aventis informed doctors and patients about these risks. In December 2015, the FDA added a statement to Taxotere's safety label that read "Cases of permanent alopecia have been reported." On the Sanofi-Aventis website, they list theproduct informationfor Taxotere, including the side effect of hair loss. They state that “in most cases, normal hair growth should return. In some cases (frequency unknown) permanent hair loss has been observed.”
Though packaging officially includes these warnings now, victims of undisclosed hair loss across the country have struggled to be recognized and taken seriously for decades. Studies and personal histories have provided ample evidence that Taxotere can cause permanent hair loss for many years, however many doctors and patients were unaware of the possibility when the drug was prescribed because the official list of side effects did not include hair loss. Even now, permanent hair loss is not listed as a common side effect, regardless of the fact that the definition of a "common side effect" is that it occurs in 1-10% of patients and 3-15% of patients. some degree of permanent hair loss after taking Taxotere.
As part of the FDA approval process, pharmaceutical company Sanofi-Aventis sponsored clinical trials of the drug. The last phase of the trial included1,060 womenwith breast cancer and began in the mid-1990s. The study's ten-year follow-up indicated that 9.2% of women struggled with permanent hair loss associated with the Taxotere, Adriamycin, and Cyclophosphamide treatment regimen, known as treatment TAC. Yet another study associated with this phase of the study involving 744 women taking TAC found that 3.9% of women experienced alopecia 8 years after completing the chemotherapy program. These side effects were not published by the company, nor did they take the opportunity to educate physicians about this new information.
The first large study to specifically focus on the link between Taxotere and permanent hair loss was conducted by Dr. Scot Sedlacek in 2006 at Rocky Mountain Cancer Centers in Denver, Colorado. He surveyed nearly 500 patients he personally treated between 1994 and 2004 with different chemotherapy regimens, some of which included Taxotere. It was found that 6.3% of patients treated with Taxotere had hair growth that was less than 50% of the rate they had before chemotherapy treatment up to 7 years after the end of treatment. In contrast, none of the women in the groups receiving chemotherapy that did not include Taxotere developed persistent alopecia. At the conclusion of your study,the warning, "Emotionally devastating long-term toxicity...must be considered when deciding on adjuvant chemotherapy regimens in women with a likely cure for breast cancer."
Since this initial study, many other researchers have found evidence of a link between Taxotere and permanent or long-term hair loss. At the 2014 National Institute for Cancer Research on Cancer Conference, a group of UK scientists presented a paper that puts the risk of hair loss even higher than previous studies. Of the 134 completed questionnaires sent by the researchers, 21 or 15.8% of patients reported persistent hair loss on the scalp 3 years after completing treatments with docetaxel (the compound marketed as Taxotere). Not only did the patients have difficulty growing hair on the scalp, "5 patients reported no eyebrow growth, 2 patients reported no eyelash growth, 6 reported no hair growth in the nostrils, and 14 reported no hair growth elsewhere, as in the legs.
In 2012, another study highlighted the connection between chemotherapy drug and permanent hair loss. A study published in the Annals of Oncology looked at 24 women suffering from Taxotere-induced alopecia. Researchers have ruled out other causes of hair loss, such as vitamin and mineral deficiencies.they concludedthat the women had very similar patterns of hair loss, often characterized by loss of eyebrows, eyelashes and hair loss over the entire scalp. Thus, in 2012, they found that "permanent and severe alopecia is a recently reported complication" of the drug regimen that includes Taxotere.
Permanent hair loss treatment
There is no permanent cure for hair loss because the hair follicles are no longer active. To prevent hair loss as much as possible, some cancer treatment centers provide patients with cool caps to wear during chemotherapy to reduce blood flow to the head while the drug is injected. This works in some cases, and to some extent, but it is far from a solution, and the effectiveness of this technique decreases as the Taxotere dose increases. For those who suffer from persistent hair loss, some dermatologists suggest topical applications of minoxidil (the active ingredient in Rogaine). Although this compound can help in some cases, it must be applied twice a day for the rest of the patient's life or the hair will fall out. Even with this schedule, minoxidil will not work for most patients and the compound can have its own toxic side effects.
Of course, even if the possibility of permanent hair loss caused by Taxotere was advertised, it is likely that many women would still choose to take the drug if there was no alternative. Regardless, patients have a right to informed consent about the drugs they are putting their bodies on, and there are alternatives to Taxotere. Pharmaceutical companies should never be allowed to withhold unfavorable information, even if it is not life-threatening, because it violates a patient's right to information and prevents them from participating in their own treatment and making the best decisions for themselves. Also, some patients may have chosen a different chemotherapy regimen if the threat of permanent hair loss has been properly reported.