1. Kazda, Roxanne


When Roxanne Kazda began chemotherapy treatment for breast cancer, she thought she was prepared for the inevitable. Her hair would go. But she wasn't prepared for the mixed emotions that accompanied the loss, nor was she ready for the subsequent deterioration of her self-esteem. As she faced the loss of her body hair, she figured that she had two choices: to laugh or to cry. She chose the former, and the only weapon she had left, her sense of humor, was honed sharp by the daily onslaught of hurdles. She clung to it as a drowning man clings to his life preserver; in the end, her sense of humor helped her to realize that she could make it through anything, as long as she could retain her ability to laugh. Following are some of her thoughts.


-Marijo Letizia, PhD, RN,C assistant professor of nursing at Loyola University, Chicago


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Figure. Roxanne Kazd... - Click to enlarge in new windowFigure. Roxanne Kazda

Everyone should see their bald head at least once during their lifetime. I've been looking at mine for quite awhile now. It makes you humble. But, there are a few good things about being without hair. For instance, shower time is a lot quicker. Plus, you never have to worry about shampoo running into your eyes. You don't have to buy shampoo anymore, and can spend the money on something fun and frivolous. Instead of shampoo, I now buy chocolate. It tastes a lot better than shampoo.


I never have a "bad hair" day! No matter how much I toss and turn, my head looks exactly the same when I wake up. Once in awhile, I brush my head, just so I don't forget how.


Now, eyebrows-that's another story! It's amazing how quickly water runs down my forehead and into my eyes without my eyebrows. I never really thought of my eyebrows as a functional item before. They're not really the kind of thing one gives much thought to-when you have them. But, try showering without them-you'll appreciate them like never before.


How 'bout leg and armpit hair? Don't have 'em-don't miss 'em. Enough said. And, we won't talk about how much we now resemble preteens in one certain area, will we?


I'm now in the daily process of closely checking my head, looking for any sign of new hair. My little routine includes standing close to the mirror with all the lights fully ablaze, my glasses on to be sure I can see the finest detail, my hand mirror held behind my head in order to reflect the light onto the top of my head. Today, I was sure I saw some peach fuzz, but I think it turned out to be dry skin. I could be wrong.


I suppose I'll have hair soon enough, but I'm anxiously awaiting this momentous occasion because I imagine I will feel something akin to Samson, with renewed strength and vitality with every quarter inch.


I've decided that the millisecond my hair is a half inch long, I'm dumping the wig. That's it. No more. The wig's a goner. This will be the one opportunity in my life to be really radical, so I might as well seize the moment. Of course, if it's 10[degrees] below zero by then, I may opt for a hat.


It's incredible how cold a person's head can get. I used to wake up during the night to go to the bathroom. Now, I wake up to put on my cap, take off my cap, put on my cap, take off my cap. My head just does not know what it wants! Of course, I have to keep reminding myself, it hasn't been bald for probably 42 and one-half years, so I'm trying to be patient.


My kids love my bald head. They think it's cool! But not cool enough to shave their own heads. They wouldn't go that far! They love to rub my head, and my favorite new feeling is when they rub their soft little cheeks right on top. They also like to pat my head for some reason. That's okay, too. They have great fun with my wig. They try it on and parade around the house and we get a great laugh.


My wig is taking on a personality; I have a love-hate relationship going on with it.


When the kids and I went to the pool the other day, I took my wig off and donned a hat to go swimming. Somehow my wig ended up in the bottom of our basket under the towels, books, lotions and everything else. We went to dry off with our towels, and got a big scare when we lifted the last towel off the pile and all jumped back when a big furry thing was revealed lying in the bottom of the basket!


I heard a funny oldie-but-goodie the other night on the car radio: "Hair," performed by The Cowsills. Remember that song? The words were hysterical, especially, "a home for the fleas, a hive for the buzzin' bees. . . ." I blasted the volume, whipped off my wig, the breeze blowing over my head, and drove down the road, bald in reverence.


Addressing Alopecia

Helping patients with cancer deal with hair loss.

Perhaps the most familiar and feared side effect of chemotherapy is alopecia, the loss of hair. According to the Y-Me National Breast Cancer Organization, "with breast cancer, personal body image concerns are already present, but baldness lets the world know." Alopecia can lead to depression, loss of self-confidence, and humiliation. In a recent study, nearly 50% of women listed hair loss as the most traumatic side effect of chemotherapy.


Causes. This troublesome consequence of cancer therapy can result when certain antineoplastic medications stop cell division in the cells of healthy hair follicles. Two additional mechanisms responsible for chemotherapy-induced hair loss are atrophy of the hair bulb and constriction of the hair shaft. Some drugs cause minimal or no hair loss, while others result in total body alopecia. The amount of hair loss depends on the kind of drugs used, the dosage given, the method of drug administration, duration of use, and patient-related factors such as nutritional status and disease process. Hair loss can be gradual or sudden. Alopecia typically begins within a few weeks of the start of treatment, and hair begins to grow back four to six weeks after treatment ends. The color, thickness, and texture of the hair may be different when regrowth occurs.


Treatment. Much of the research on alopecia has focused on its psychosocial impact and on methods of reducing hair loss during cancer treatment. While scalp tourniquets, ice turbans, and other cooling techniques are intended to decrease the blood supply to the hair follicles, studies have failed to produce specific recommendations regarding the use of scalp hypothermia to prevent chemotherapy-induced alopecia.


Nurses have both an opportunity and a responsibility to address the experience of hair loss with patients undergoing chemotherapy. Their personal experiences and social support will help their responses to hair loss. Because hair contributes significantly to one's body image, the loss of it can be associated with cosmetic concerns and changes in self-esteem. Therapeutic interventions are designed to help patients and their families adapt to and cope with these changes. For example, it's particularly helpful for nurses to educate patients about hair loss before it occurs. Review hair and scalp care and discuss the use of head coverings such as wigs, scarves, and hats. Instruct patients to be gentle when brushing or combing hair, to wash the scalp with mild soap, to avoid sunburn, and to lubricate the scalp with oil or ointment to reduce itching.


It's especially important for patients to have an opportunity to discuss their concerns and feelings about alopecia. Agencies such as the American Cancer Society (ACS) offer valuable programs, many of which are free to patients with cancer. For example, by providing advice and consultation on cosmetics and head coverings, the "Look Good, Feel Better" seminars help women undergoing cancer treatment to enhance their appearance and self-image. In addition to providing practical tips to women experiencing treatment-induced alopecia, this program provides an opportunity for them to meet. In another ACS program, "Reach to Recovery," breast cancer survivors volunteer to support patients during diagnosis, treatment, and recovery. Also in a similar vein, the "I Can Cope" course, sponsored by the University of Michigan Comprehensive Cancer Center and the ACS, gives patients and family members the skills and information necessary to deal with the cancer experience.


-Marijo Letizia PhD, RN,C, assistant professor of nursing at Loyola University, Chicago




Munstedt K, et al. Changes in self-concept and body image during alopecia-induced cancer chemotherapy. Support Care Cancer 1997; 5 (2):139-43.


Pickard-Holley S. The symptom experience of alopecia. Semin Oncol Nurs 1995; 11 (4):235-8.


Williams J, et al. A narrative study of chemotherapy-induced alopecia. Oncol Nurs Forum 1999; 26 (9):1463-8.