Alopecia as a Factor of Psychological Distress in the Treatment of Malignant Breast Neoplasm in a Black Woman: Case Report

ABSTRACT

Introduction:  Chemotherapy-induced alopecia is a very common side effect of breast cancer treatments and the scalp cooling method has become the most used to prevent this reaction. Although more widely used, this method causes some adverse effects that are difficult to bear, and for the black population, some points need to be further discussed. The objective of the study is to describe psychological suffering in the treatment of malignant breast neoplasia in black women.

Case report:  Young black woman, with curly hair diagnosed with malignant breast neoplasia, historically affected by structural racism during childhood and adolescence, prefers to start chemotherapy treatment associated with cryotherapy. During treatment, she coped with psychological suffering with resilience and her speech expressed consolidated resources.

Conclusion:  The cryotherapy procedure needs further advances to be more effective in containing frizzy hair alopecia. Furthermore, more studies on the process of oncological illness in black people and the impacts involved are needed.

Key words:
Breast Neoplasms; Alopecia Areata/chemically induced; Cryotherapy; Psychological Distress; Black People

RESUMO

Introdução:  A alopecia induzida por quimioterapia é um efeito colateral muito comum em tratamentos para câncer de mama, e o método de resfriamento do couro cabeludo tornou-se o mais utilizado para prevenir essa reação. Embora mais utilizado, esse método acarreta alguns efeitos adversos difíceis de suportar e, para população negra, alguns pontos precisam ser mais discutidos. O objetivo do estudo é descrever o sofrimento psíquico no tratamento de neoplasia maligna de mama em mulher negra.

Relato do caso:  Mulher jovem, negra, cabelos crespos, com diagnóstico de neoplasia maligna de mama, historicamente afetada pelo racismo estrutural durante a infância e adolescência, opta por iniciar o tratamento quimioterápico associado à crioterapia. Durante o tratamento, demonstra enfrentamento ao sofrimento psíquico com resiliência e consolidados recursos de enfrentamento no discurso.

Conclusão:  O procedimento de crioterapia necessita de mais avanços para maior eficácia na contenção da alopecia de cabelos crespos, além disso mais estudos fazem-se necessários sobre o processo de adoecimento oncológico em pessoas negras e seus impactos envolvidos.

Palavras-chave:
Neoplasias da Mama; Alopecia em Áreas/induzido quimicamente; Crioterapia; Angústia Psicológica; População Negra

RESUMEN

Introducción:  La alopecia inducida por quimioterapia es un efecto secundario muy común en los tratamientos para el cáncer de mama y el método de enfriamiento del cuero cabelludo se ha convertido en el más utilizado para prevenir esta reacción. Aunque se utiliza más ampliamente, este método provoca algunos efectos adversos que son difíciles de soportar, y para la población negra es necesario discutir más a fondo algunos puntos. El objetivo del estudio es describir el sufrimiento psicológico en el tratamiento de la neoplasia maligna de mama en mujeres de raza negra.

Informe del caso:  Mujer joven, negra, de cabello rizado diagnosticada con neoplasia maligna de mama, históricamente afectada por racismo estructural durante la infancia y adolescencia, opta por iniciar tratamiento de quimioterapia asociado a crioterapia. Durante el tratamiento, demuestra afrontar el sufrimiento psicológico con resiliencia y recursos de enfrentamiento consolidados en su discurso.

Conclusión:  El procedimiento de crioterapia necesita más avances para ser más eficaz en la contención de la alopecia para cabello rizado. Además, se necesitan más estudios sobre el proceso de enfermedad oncológica en personas de raza negra y los impactos involucrados.

Palabras clave:
Neoplasias de la Mama; Alopecia por Áreas/inducida químicamente; Crioterapia; Angustia Psicológica; Población Negra

INTRODUCTION

Breast cancer is the most prevalent among women's oncologic diseases. Alopecia is one of the side effects of the antineoplastic treatment. Hair loss results from strong aggression to the hair strand during treatment leading to chemotherapy-induced alopecia¹.

Most of the breast cancer chemotherapy protocols causes this feared effect on all women affecting their self-esteem and social image¹. Scalp cooling method is the most indicated to reduce alopecia². Hair cryotherapy is a technique that uses cold caps for vasoconstriction reducing the amount of chemotherapy that reaches the hair follicles and avoid hair loss³,⁴. Most of the users report that the adverse effects as headache and chills are bearable according to recent studies². However, some women do not tolerate and prefer other alternatives.

Given that the hair is a critical element of subjective identification of self-image, many are the psychologic repercussions. Black women in Brazil still have poor access to healthcare due to social reasons, a literature review about quality of life of Black women with breast cancer⁴ indicates that so far there are no studies associating the three descriptors – quality of life, Black women and breast cancer. However, 103 articles addressing one of the three descriptors have been identified.

The goal of this study is to understand the dynamics of the psychic suffering of Black women, historically affected by structural racism in face of a diagnosis of breast cancer that can cause hair loss and impacts their ethnical identity. It is a case report followed up at an oncologic clinic in Salvador, Bahia, between February and July 2024.

The Ethic Committee of "Hospital Santa Izabel" approved the study, report 7,189,655 (CAAE (submission for ethical review): 83220824.3.0000.5520), in compliance with Directives 466/2012⁵ and 510/2016⁶ of the National Health Council.

The clinical case was correlated with the specialized literature and a bibliographic review has been performed. Oncologic treatment with chemotherapy began in March and the multi-professional evaluation was conducted from March to July 2024. The patient was informed about the interest of presenting a case report and eventually signed the Informed Consent Form (ICF). The patient's chart was analyzed by psychologists, nurses and pharmacists.

CASE REPORT

Black woman, 32 years of age, childless, diagnosed with breast cancer in February 2024 initiated treatment with paclitaxel followed by doxorubicin and cyclophosphamide supported by granulocyte stimulating factor after consultation with the multi-professional team.

After admission by nurse and pharmacist, the patient was briefed about the treatment, its effects and cryotherapy, standing out alopecia as the most frequent adverse effect.

The patient opted for cryotherapy, was guided to use hypothermal cap before and after chemotherapy in addition to avoid heat, chemical products and excessive friction to protect hair strands³.

At admission, the patient shared with the psychologist the impact of the diagnosis for a woman of her age, and mentioned the interruption of graduation in nutrition. The psychologist discussed the grief associated with sickening, the patient already expressed feelings of loss and how she would have to adapt to a new reality.

Her major suffering was the potential hair loss, important for her self-image, she hoped to avoid alopecia with cryotherapy but in the next sessions, she reported pain and discomfort that could affect the continuity of the treatment.

The patient associated her visual identity with hair, in her perspective it represented wishes and identity. As a young Black woman, she faced challenges during adolescence and had to straighten her hair to feel less excluded.

In adulthood, she adopted the natural black style representing identity and power. Hair loss meant to lose part of her history and cope with perceived fragility and vulnerability. Being listened to validated her suffering, helping her to make her own reflections; as she had already overcome social and racial challenges to construct her identity, she could resignify this moment and find herself again.

The patient interrupted the cryotherapy after the second cycle due to alopecia and intense discomfort, preferring to shave her hair, instead. She was resilient and her coping resources were consolidated, she did not want to wear wig and continued with the treatment to the end. While reflecting about her racial experiences, she felt psychically stronger and the necessity of coping with the pain and reinvent herself.

In addition, one of her strategies for physical, social, psychic and spiritual well-being was jogging, an activity closely related to her identity. At the end of the treatment, she was grateful for her own choices, especially the interruption of cryotherapy, reflecting about hair loss and resignification of this experience.

DISCUSSION

Chemotherapy-induced alopecia depends on type and dose, usually occurring in 60-100% of the cases of breast cancer treatment. Combined therapy can increase the incidence of alopecia more frequent in the first weeks of the treatment⁷-⁹.

Cryotherapy causes local vasoconstriction, reduces the volume and effect of the drugs on hair scalp while diminishing the metabolism of hair follicles¹⁰.

The treatment proposed raises a crucial and subjective aspect. Multidisciplinary follow-up was essential for the present case, highlighting its relevance in oncology. The patient narrative revealed the importance of her life history and validation of her wishes during sickening. Since the diagnosis, it was possible to observe the emotional suffering caused by symbolic losses and change of routine, habits and projects, the beginning of a grieving process¹¹-¹³.

The patient received support to decide about the treatment and opted for not submitting to cryotherapy. The case has also prompted the team to reflect on the prescription for individuals with curly hair as there are no proven evidences of the efficacy for this population¹³. The study encourages the reflection about the necessity of inclusive and comprehensive practices.

CONCLUSION

Cryotherapy needs improvement for better efficacy to contain alopecia in curly hairs. An important topic was the discussion of structural racism since the initial planning of the procedure because it was not considered for all types of hair.

The argument around the prescription of cryotherapy for individuals with curly hair is relevant because it is possible that it was not initially meant for that type of hair (straighten curly, straight without volume, use of chemical products or dyed, among others). Risks and benefits should be presented clearly given the discomfort caused by the procedure and psychic repercussions, including frustration.

The case report was based on a single experience, it is recommended that more studies about oncologic sickening in Black individuals, the psychologic impacts and losses, structural racism and other procedures concomitant to oncologic treatment, as cryotherapy – currently more accessible to White individuals – should be conducted. Further advances are anticipated on that matter.

• FUNDING SOURCES
  None.

DATA AVAILABILITY STATEMENT

All content underlying the text is contained in the manuscript.

ACKNOWLEDGMENTS

To the co-workers who support and assist the patients in oncologic treatment and to the patients who shared their experiences and inspire everyone to expand the knowledge.

References

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Edited by

• Scientific-editor:
  Anke Bergmann. Orcid iD: https://orcid.org/0000-0002-1972-8777

Publication Dates

• Publication in this collection
  29 Sept 2025
• Date of issue
  2025

History

• Received
  16 Apr 2025
• Accepted
  24 July 2025