**8. Acknowledgment**

This work was supported by the NIH grants HL076340, HL076340-04S1, and HL095579.

#### **9. References**


Even if CIA cannot be completely prevented, it can be managed. Healthcare providers and patient family could help patients prepare for the sudden loss of hair, thus minimizing the negative impact on patients. Patients should receive the information regarding self-care strategies to take control and cope with CIA. Patients with long hair should be encouraged to try short hair style to make a better transition to total CIA. Patients are also advised to avoid physical and chemical trauma to the hair (e.g. bleaching, coloring and perming) and to shave their hair once the hair loss becomes prominent. Appropriate head covering may be

This work was supported by the NIH grants HL076340, HL076340-04S1, and HL095579.

Alonso, L. & Fuchs, E. (2006) The hair cycle. *Journal of Cell Science* Vol.119, No.3 (January

Aosh, S.; Ohtsu, T. & Ohta, S. (2000) The super anti-apoptotic factor Bcl-xFNK constructed

Apisanthanarax, N. & Duvic, M. (2003) Dermatologic complications of cancer

Batchelor, D. (2001). Hair and cancer chemotherapy: consequences and nursing care—a

Bodo, E.; Tobin, D. J.; Kamensich, Y.; Biro, T.; Berneburg, M.; Funk, W. & Paus, R. (2007)

Botchkarev, V. A.; Komarova, E. V.; Siebenhaar, F.; Botchkareva, N. V.; Komarov, P. G.;

Braun, S.; Krampert, M.; Bodo, E.; Kumin, A.; Born-Berclaz, C.; Paus, R. & Werner, S. (2006)

Balsari, A. L.; Morelli, D.; Menard, S.; Veronesi, U. & Colnagho, M. I. (1994) Protection

*Science* Vol.110, No.Pt 23, (November 2006), pp. 4841-4849.

*Chemistry* Vol.275, No.47, (November 2000), pp. 37240-37245.

by disturbing intramolecular polar interactions in rat Bcl-xL. *The Journal of Biological* 

chemotherapy, In: *Frei Cancer Medicine*, R. C. Bast; D. W. Kufe; R. E. Pollock; R. R. Weichsellbaum; J. F. Holland & E. Frei, (5), 2271-2278, BC Decker, Hamilton,

literature study. *European Journal of Cancer Care* Vol.10, No.3, (September 2001), pp.

Dissecting the impact of chemotherapy on the human hair follicle. A pragmatic in vitro assay for studying the pathogenesis and potential management of hair follicle dystrophy. *The American Journal of Pathology* Vol.171, No.4, (October 2007), pp.

Maurer, M.; Gilchrest, B. A. & Gudkov, A. V. (2000) p53 is essential for chemotherapy-induced hair loss. *Cancer Research* Vol.60, No.18, (September 2000),

Keratinocyte growth factor protects epidermis and hair follicles from cell death induced by UV irradiation, chemotherapeutic or cytotoxic agents. *Journal of Cell* 

against doxorubicin-induced alopecia in rats by liposome-entrapped monoclonal antibodies. *The FASEB Journal* Vol.8, No.2, (February 1994), pp.

used, depending on individual preference (Bachelor, 2001; Trueb, 2010).

**8. Acknowledgment** 

2006), pp. 391-393.

London.

147-163.

1153-1167.

pp. 5002-5006.

226-230.

**9. References** 


Chemotherapy-Induced Alopecia 69

Janssen, F-P. E. M.; Bouten, C. V. C.; van Leeuwen, G. M. J. & van Steenhoven, A. A. (2008)

Jimenez, J. J. & Yuniz A. A. (1992) Protection from chemotherapy-induced alopecia by 1,25-

Jimenez, J. J. & Yunis, A. A. (1996) Vitamin D3 and chemotherapy-induced alopecia.

Jimenez, J. J.; Roberts, S. M.; Mejia, J.; Mauro, L. M.; Munson, J. W.; Elgart, G. W.; Connelly,

Kampinga, H. H. (1995) Hyperthemia, thermotolerance and topoisomerase II inhibitors.

Kobayashi, T.; Okumura, H.; Hashimoto, K.; Asada, H.; Inui, S. & Yoshikawa, K. (1998)

Krause, K. & Foitzik, K. (2006) Biology of the hair follicle. *Seminars in Cutaneous Medicine and* 

Kwak, H. J.; Jun, C. D., Pae, H. P., Yoo, J. C.; Park, Y. C.; Choi, B. M.; Na, Y. G.; Park, R. K.;

Li, P.; Nijhawan, D.; Budihardjo, I.; Srinivasula, S. M.; Ahmad, M.; Alnemn, E. S. & Wang, X.

Lindner, G.; Botchkarev, V. A.; Botchkareva, N. V.; Ling, G.; van der Veen, C. & Paus, R.

Lutz, G. (1994) Effects of cyclosporin A on hair. *Skin Pharmacology* Vol.7, No.1-2, (1994), pp.

Matsumoto, Y.; Hayakawa, A.; Tamada, Y.; Mori, H. & Ohashi, M. (1996) Upregulated

McGravey, E. L.; Baum, L. D.; Pinkerton, R. C. & Rogers L. M. Psychological sequelae and

*Journal of Pathology* Vol.151, No.6, (December 1997), pp. 1601-1617.

*British Journal of Cancer* Vol.72, No.2, (August 1995), pp. 333-338.

Nutrition Vol.12, No.6, (June 1996), pp. 448-449.

Vol.13, No.1, (February 2008), pp. 31-38.

*Science* Vol.17, No.2, (June 1998), pp. 108-114.

*Surgery* Vol.25, No.1, (March 2006), pp. 2-10.

No.1, (July 1998), pp. 1-12.

489.

101-104.

1996), pp. 267-269.

(November/December 2001), pp. 283-289.

2007), pp. 829-839.

2008), pp. 81-86.

5125.

perfusion during scalp cooling. *Physiological Measurement* Vol.28, No.8, (August

Effects of temperature and doxorubicin exposure on keratinocyte damage in vitro. *In Vitro Cellular and Developemental Biology. Animal* Vol.44, No.304, (March-April

dihydroxyvitamind D3. *Cancer Research* Vol.52, No.18, (September 1992), pp. 5123-

E. A.; Chen, Q.; Zou, J.; Goldenberg, C. & Voellmy, R. (2008) Prevention of chemotherapy-induced alopecia in rodent models. Cell Stress and Chaperones

Synchronization of normal human keratinocytes in culture: its application to the analysis of 1,25-dihydroxyvitamin D3 effects on cell cycle*. Journal of Dermatological* 

Chung, H. T.; Chung, H. Y.; Park, W. Y. & Seo, J. S. (1998) The role of inducible 70 kDa heat shock protein in cell cycle control, differentiation, and apoptotic cell death of the human myeloid leukemic HL-60 cells. *Cellular Immunology* Vol.187,

(1997) Cytochrome c and dATP-dependent formation of Apaf-1/caspase-9 complex initiates an apoptotic protease cascade. *Cell* Vol.91, No.4, (November 1997), pp. 479-

(1997) Analysis of apoptosis during hair follicle regression (catagen). *American* 

expression of Fas antigen on cultured human keratinocytes with induction of apoptosis by cisplatin. *Archieves for Dermatological Research* Vol.288, No.5-6, (May

alopecia among women with cancer. *Cancer Practise* Vol.9, No.6,


Grevelman, E. G. & Breed, W. P. M. (2005) Prevention of chemotherapy-induced hair

Han, J. H.; Kwon, O. S.; Chung, J. H.; Cho, K. H.; Eun, H. C. & Kim, K. H. (2004) Effect

Hardy, M. H. (1992) The secret life of the hair follicle. *Trends in Genetics* Vol.8, No.2,

Hendrix, S.; Handjiski, B.; Peters, E. M. J. & Paus, R. (2005) A guide to assessing damage

Hidalgo, M.; Rinaldi, M.; Medina, G.; Griffin, T.; Turner, J. & Van Hoff, D. D. (1999) A phase

Huges, M. D.; Hussain, M.; Nawaz, Q.; Sayyed, P. & Akhtar, S. (2001) The cellular delivery

Hussein, A. M.; Jimenez, J. J.; McCall, C. A. & Yunis, A. A. (1990) Protection from

Hussein, A. M. (1991) Interleukin-1 protects against 1-beta-D-Arabinofuranosylcytosine-

Hussein, A. M. (1993) Chemotherapy-induced alopecia: New developments. *Southern* 

Hussein, A. M.; Stuart, A. & Peters, W. P. (1995) Protection against chemotherapy-induced

Ishino, A.; Uzuka, M.; Tsuji, Y.; Nakanishi, J.; Hanzawa, N. & Imamura S. (1997) Progressive

Ito, H.; Shimojo, T.; Fujisaki, H; Tamamori, M.l Ishiyama, S.; Adachi, S.; Abe, S.; Marumo, F.

Jaattela, M.; Wissing, D.; Kokholm, K.; Kallunki, T. & Egeblad, M. (1998) Hsp70 exerts its

Janssen, F. E. M.; Rajan, V.; Steenbergen, W.; van Leeuwen, G. M. J. & van Steenhoven, A. A.

*Meidcal Journal* Vol.86, No.5, (May 1993), pp. 489-496.

*Dermatology* Vol.24, No.12, (Dec 1997), pp. 758-764.

Vol.17, No.21, (November 1998), pp. 6124-6134.

358.

98.

pp. 42-51.

393-395.

761.

(February 1992), pp. 55-61.

(March 2001), pp. 305-315.

1995), pp. 3329-3330.

No.3, (1995), pp. 192-196.

(September 1990), pp.1564-1566.

loss by scalp cooling. *Annals of Oncology* Vol.16, No.3, (January 2006), pp. 352-

of minoxidil on proliferation and apoptosis in dermal papilla cells of human hair follicle. *Journal of Dermatological Science* Vol.34, No.2, (April 2004), pp. 91-

response pathways of the hair follicle: Lessons from cyclophosphamide-induced alopecia in mice. *The Journal of Investigative Dermatology* Vol.125, No.1, (July 2005),

I trial of topical topitriol (calcitriol, 1,25-dihydroxyvitamin D3) to prevent chemotherapy-induced alopecia. *Anticancer Drugs* Vol.10, No.4, (April 1999), pp.

of antisense oligonucleotides and ribozymes. *Drug Discovery Today* Vol.6, No.6,

chemotherapy-induced alopecia in a rat model. *Science* Vol.249, No.4976,

induced alopecia in the newborn rat model. *Cancer Research* Vol.51, No.12 , (June

alopecia by cyclosporine A in the newborn rat animal model. *Dermatology* Vol.190,

decrease in hair diameter in Japanese with male pattern baldness. *Journal of* 

& Hiroe, M. (1999) Thermal preconditioning protects rat cardiac muscle cells from doxorubicin-induced apoptosis. *Life Sciences* Vol.64, No.9, (January 1999), pp. 755-

anti-apoptotic function downstream of caspase-3-like proteases. *The EMBO Journal*

(2007) The relationship between local scalp skin temperature and cutaneous

perfusion during scalp cooling. *Physiological Measurement* Vol.28, No.8, (August 2007), pp. 829-839.


Chemotherapy-Induced Alopecia 71

Schilli, M. B.; Paus, R. & Menrad, A. (1998) Reduction of intrafollicular apoptosis in

Sharov, A. A.; Li, G. Z.; Palkina, T. N.; Sharova, T. Y.; Gilchrest, B. A. & Botchkarev, V. A.

Sharov, A. A.; Siebanhaar, F.; Sharova, T. Y.; Botchkareva, N. V.; Gilchrest, B. A. &

Simon, H. U.; Haj-Yehia, A. & Levi-Schaffer, F. (2000) Role of reactive oxygen species

Spiegel, D. & Giese-Davis, J. (2003) Depression and cancer: mechanisms and disease progression. *Biological Psychiatry* Vol.54, No.3, (August 2003), pp. 269-282. Sredeni, B.; Xu, R. H.; Albeck, M.; Gafter, U.; Gal, R.; Shani, A.; Tichler, T.; Shapira, J.;

International Journal f Cancer Vol.65, No.1, (January 1996), pp. 97-103. Stenn, K.S. & Paus, R. (2001) Control of hair follicle cycling. *Physiological Reviews* Vol.81,

Taylor, M.; Ashcroft, A. T. & Messenger, A G. (1993) Cyclosporin A prolongs human hair

Trueb, R.M. (2002) Molecular mechanisms of androgenetic alopecia. *Experimental Gerontology*

Tsuda, T.; Ohmori, Y.; Muramatsu, H.; Hosaka, Y.; Takigushi, K.; Saitoh, F.; Kato, K.;

Trueb, R. M. (2009) Chemotherapy-induced alopecia. *Seminars in Cutaneous Medicine and* 

Trueb, R. M. (2010) Chemotherapy-induced alopecia. *Current Opinion in Supportive and* 

Wang, J.; Lu, Z. & Au, J. L. S. (2006) Protection against chemotherapy-induced alopecia. *Pharmaceutical Research* Vol.23, No.11, (November 2006), pp. 2505-2514. Wilkes, G. M. (1996) Potential toxicities and nursing management, In: *Cancer Chemotherapy: a* 

*Nursing Process Approach*, M. Barton Burke; G. M. Wilkes & K. Inguersen, (2), 130-

Vol.37, No.8-9, (August-September 2002), pp. 981-990.

*Palliative Care* Vol.4, No.4, (December 2010), pp. 281-284.

*Dermatology* Vol.111, No.4, (October 1998), pp. 598-604.

*Dermatology* Vol.120, No.1, (January 2003), pp. 27-35.

6266-6270.

No.1, (January 2001), pp. 449-494.

No.1, (December 2001), pp. 43337-43345.

135, Jones & Bartlet, Boston.

*Surgery* Vol.28, No.1, (March 2009), pp. 11-14.

418.

365-369.

chemotherapy-induced alopecia by topical calcitriol-analogs. *Journal of Investigative* 

(2003) Fas and c-kit are involved in the control of hair follicle melanocyte apoptosis and migration in chemotherapy-induced hair loss. *Journal of Investigative* 

Botchkarev, V. A. (2004) Fas signalling is involved in the control of hair follicle response to chemotherapy. *Cancer Research* Vol.64, No.17, (September 2004), pp.

(ROS) in apoptosis induction. *Apoptosis* Vol.5, No.5, (November 2000), pp. 415-

Bruderman, I.; Catanae, R.; Kaufman, B.; Whisnant, J. K.; Mettinger, K. L. & Kalechman, Y. (1996) The protective role of immunomodulator AS101 against chemotherapy-induced alopecia studies on human and animal models.

growth *in vitro*. *Journal of Investigative Dermatology* Vol.100, No.3, (March 1993), pp.

Nakayama, K.; Nakamura, N.; Nagata, S. & Mochizuki, H. (2001) Inhibitory effect of M50054, a novel inhibitor of apoptosis, on anti-Fas-antibody-induced hepatitis and chemotherapy-induced alopecia. European Journal of Pharmacology Vol.433,


Messenger, A. G. & Rundegren, J. (2004) Minoxidil: mechanisms of action on hair

Muller, M.; Wilder, S.; Bannasch, D.; Israeli, D.; Lehlbach, K.; Li-Weber, M.; Friedman,

Munstedt, K.; Manthey, N.; Sachsse, S. & Vahrson, H. (1997) Changes in self-concept and

Nakashima-Kamimura, N.; Nishimaki, K.; Mori, T.; Asoh, S. & Ohta, S. (2008) Prevention of

O'Leary, A. (1990) Stress, emotion, and human immune function. Psychological Bulletin

Ohnemus, U.; Uenalan, M.; Inzunza, J.; Gustafsson, J. A. & Paus, R. (2006) The hair follicle as

Paus, R.; Stenn, K. S. & Link, R. E. (1989) The induction of anagen hair growth in telogen

Paus, R.; Handjiski, B.; Eichmuller, S. & Czarnetzki, B. M. (1994) Chemotherapy-induced

Paus, R.; Schilli, M. B.; Handjiski, B.; Menrad, A.; Henz, B.M. & Plonka, P. (1996) Topical

Peters, E. M.; Foitzik, K.; Paus, R.; Ray, S. & Holick, M. F. (2001) A new strategy for

Porter, A. G. & Janicke, R. U. (1999) Emerging roles of caspase-3 in apoptosis. *Cell Death and* 

Pozo-Kaderman, C.; Kaderman, R. A. & Toonkel R. (1999) The psychological aspects of

Sakita, S.; Ohtani, O. & Morohashi, M. (1995) Dynamic changes in the microvascular

Sawaya, M. E. (2001) Regulation of the human hair cycle. *Current Problem in Dermatology*

*Differentiation* Vol.6, No.2, (February 1999), pp. 99-104.

Vol.28, No.3-4, (November 1995), pp. 187-192.

Vol.13, No.3, (May 2001), 206-210.

194.

706.

4443.

171-178.

174.

(December 1998), pp. 2033-2045.

Vol.5, No.2, (March 1997), pp. 139-143.

No.3-4, (January 2008), pp. 218-225.

(March 1989), pp. 365-369.

1994), pp. 719-734.

Vol.108, No.3, (November 1990), pp. 363-382.

growth. *British Journal of Dermatology* Vol.150, No.2, (February 2004), pp. 186-

S. L.; Galle, P. R.; Stremmel, W.; Oren, M. & Krammer, P. H. (1998) p53 activates the CD95 (Apo-1/Fas) gene in response to DNA damage by anticancer drugs. *The Journal of Experimental Medicine* Vol.188, No.11,

body image during alopecia induced cancer chemotherapy. *Support Care Cancer*

hemotherapy-induced alopecia by anti-death FNK protein. *Life Sciences* Vol.82,

an estrogen target and source. *Endocrine Reviews* Vol.27, No.6, (July 2006), pp. 677-

mouse skin by cyclosporine A administration. *Laboratory Investigation* Vol.60, No.3,

alopecia in mice induction by cyclophosphamide, inhibition by cyclosporine A, and modulation by dexamethasone. *American Journal of Pathology* Vol.144, No.4, (April

calcitriol enhances normal hair regrowth but does not prevent chemotherapyinduced alopecia in mice. *Cancer Research* Vol.56, No.19, (October 1996), pp. 4438-

modulating chemotherapy-induced alopecia, using PTH/PTHrP receptor agonist and antagonist. *Journal of Investigative Dermatology* Vol.117, No.2, (August 2001), pp.

breast cancer. *Nursing Practitioner Forum* Vol.10, No.3, (September 1999), pp. 165-

architecture of rat hair follicles during the hair cycle. *Medical Electron Microscopy*


**6** 

*Australia* 

J. M. Ussher, J. Perz, E. Gilbert, Y. Hawkins and W. K. T. Wong *University of Western Sydney,* 

**Sexuality and Intimacy in the Context of Cancer** 

**1.1 The impact of cancer on sexuality and intimacy: A key aspect of quality of life**  In 2006, more than 106,000 new cases of cancer were diagnosed in Australia, with the number of new cases in New South Wales alone expected to grow to 40,116 by 2011 (AIHW et al., 2007, Tracey et al., 2005). It is now widely recognised that cancer and its treatment can have a significant effect on the quality of life of both people with cancer (Stommel et al., 2004) and their family members, in particular their intimate partner (Hodges et al., 2005). Sexuality and intimacy are important aspects of an individual's quality of life (World Health Organisation, 1995), and there is a growing body of evidence to show that cancer can result in dramatic changes to sexuality, sexual functioning, relationships, and sense of self, regardless of cancer type. Indeed, these changes can be experienced as the most significant

For women, treatments for gynaecological, colorectal, or breast cancer can alter patterns of fertility, have a negative impact on arousal and orgasm, reduce vaginal lubrication and elasticity (Jvaskova et al., 2003), precipitate negative changes to body image and sense of self, or precipitate 'sexual dysfunction' (Maughan et al., 2002, Sundquist, 2002, Baider et al., 2000). For men, prostate and testicular cancer can impact on fertility, ejaculatory capacity, and erectile potential (Gurevich et al., 2004), as well as provoking diminished confidence, fear, and embarrassment associated with sexual ability (Bokhour et al., 2001). The fatigue caused by cancer and certain treatments, such as chemotherapy and radiotherapy, is also

Changes to sexuality post-cancer have ramifications beyond sex as an activity. It has been argued that when sexual intercourse ceases after illness, touching and other forms of affectionate physical contact also diminish (Kuyper et al., 1998), because of a perception amongst some couples that these forms of affection necessarily lead to sexual intercourse, which is either not possible, or deemed inappropriate (Hughes, 2000). Equally, if all forms of sexual intimacy within the couple relationship disappear, couples facing cancer can feel isolated, anxious, depressed (Germino et al., 1995), inadequate (Anllo, 2000), or emotionally distant from their partner (Rolland, 1994). Conversely, sexual intimacy has also been found to make the experience of cancer more manageable and assist in the recovery process (Schultz et al., 2003), or be central to couple closeness and quality of life in palliative care

in the person with cancer's life (Anderson et al., 2000).

typically associated with diminished desire (Rolland, 1994).

**1. Introduction** 

(Lemieux et al., 2004).

