The physical, psychological and social experiences of alopecia among women receiving chemotherapy: An integrative literature review

Abstract

To conduct an integrative scoping review of the physical, psychological and social experiences of women who have experienced chemotherapy-induced alopecia (CIA). Method: An integrative review was undertaken. A systematic search of MEDLINE, CINAHL and PsycInfo identified 23 studies meeting the inclusion criteria. Data relating to women's experiences of alopecia was extracted and synthesized thematically. Results: Four analytical themes were formed; 'the physical and psychological effect of alopecia', 'more than the loss of hair', 'the complexities of a visual cancer identity' and 'coping with new internal and external relationships'. CIA involves a public and private representation of illness which disrupts women's identity and their acceptance in public, yet this is a highly individualised experience. There is disparity in current evidence regarding the experience of CIA for women among older age groups, with rarer forms of cancer, haematological malignancies and those receiving palliative care or targeted treatment modalities. Conclusions: This review highlights the continued pervasive psychosocial implications arising from CIA, however this is not exclusive to scalp hair as alopecia from the face and body has also been found to require adaptation and effective coping. Limited knowledge exists on the experience of alopecia induced by treatment for haematological cancers and rarer-tumour groups and emerging systemic anti-cancer treatment modalities. Healthcare professionals must endeavour to support and discuss the potential risks of alopecia, and provide patients with an opportunity to voice their fears, concerns, and experiences of CIA. Future research should incorporate the identified underserved populations and the experience of newer therapies.

Shared decision making for patients with breast and gynecologic malignancies undergoing chemotherapy associated with persistent alopecia

“…Despite these limitations, this is the first study to assess how perceived involvement in shared decision making among patients with breast cancer compares to that of patients with gynecologic cancer when considering the risks and benefits of chemotherapy and potential for pCIA. Given the body of published literature on shared decision making and the extent of distress caused by CIA among patients with breast cancer, ( Spaich et al, 2018 , Boland et al, 2020 ) our results suggest that this knowledge can be extrapolated to patients with gynecologic cancer. Shared decision making and patient-centered care will be especially important in the future as new anticancer therapies emerge and improved survival outcomes lead to more cancer survivors at risk for pCIA.…”

“…( Shen et al, 2018 ) Compared to other cancers, significantly less research has been done to explore the impact of CIA in patients with gynecologic cancers undergoing cytotoxic treatment—a population that is often greatly impacted by treatment-related side effects. ( Boland et al, 2020 ) A qualitative study examining CIA in women with ovarian cancer demonstrated that hair loss was a major concern, with some women describing it as being more traumatic than their ovarian cancer diagnosis. ( Jayde et al, 2013 ) While both breast and gynecologic cancers predominantly affect women and are psychosocially linked to womanhood, there are distinct differences between these cancers.…”

“…Much of the literature on shared decision making and the impact of pCIA is focused on breast cancer. ( Spaich et al, 2018 , Boland et al, 2020 ) Patients with gynecologic malignancies are frequently treated with similar alopecia-inducing cytotoxic regimens; however, knowledge surrounding patient-physician communication patterns and the burden of pCIA in the setting of gynecologic cancers is lacking. The objective of our study was to assess the shared decision making perspective of patients with breast or gynecologic cancer undergoing chemotherapy regimens that can cause pCIA.…”

Ethical, legal, organizational and social issues related to the use of scalp cooling for the prevention of chemotherapy‐induced alopecia: A systematic review

“…Alopecia is one of the most common and visible adverse effects of chemotherapy, which affects approximately 65% of all patients undergoing chemotherapy 1,2 …”

“…Alopecia is one of the most common and visible adverse effects of chemotherapy, which affects approximately 65% of all patients undergoing chemotherapy. 1,2 Although chemotherapy-induced alopecia (CIA) is not lifethreatening and in most cases is reversible, it can have a significant impact on a patient's quality of life, especially in psychological and social terms. 3,4 While it has long been considered an acceptable side effect in the treatment of patients, the increasing number of cancer survivors and a better understanding of the associated psychological processes have led to a greater consideration of CIA as a relevant problem.…”