BALTIMORE, Md. -- With thinning brown hair and nearly invisible eyebrows, Margaret Fisher sits her frail frame down in the salon chair. She received a diagnosis of Stage IV pancreatic cancer almost two years ago and has undergone 18 radiation treatments and six rounds of chemotherapy since. A hairstylist places a wig on Fisher's head and draws eyebrows on her bare face. Fisher, 63, looks in the mirror and smiles.
Such smiles are common at the Image Recovery Center, a beauty salon inside the Johns Hopkins Sidney Kimmel Comprehensive Cancer Center in Baltimore, Md. In this small, out-of-the-way room, cosmetologists specialize in assisting cancer patients who lose their hair, experience changes to their skin or have breasts surgically removed.
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Self-image's effect on health and recovery is a topic filled with anecdotal evidence but few data. Nonetheless, doctors and nurses are finding that paying attention to what might be seen as superficial concerns -- hair and makeup -- has a positive effect on patients, with beauty regimes being bright spots in what can be a dreary journey through radiation and other therapies. Because of these perceived benefits, programs focused on cosmetic solutions are spreading.
Andrew Thompson, who teaches clinical psychology at the University of Sheffield in England, does research on the ways people adjust to what he calls "appearance-altering conditions." Exploring patients' psychological reactions, he suggests, may lead to interventions that can ease their distress.
The Image Recovery Center takes a concrete approach to image problems, as does the Look Good ... Feel Better program of the American Cancer Society. In 2002 the program released findings of a survey showing that "86 percent of women cancer patients said that looking good helps them feel better and gives them more confidence to cope with their disease."
"I've heard patients say, 'I absolutely feel ugly. I don't want to look at myself. When I look in the mirror I don't see the same person,'" said Marianne Kelly, who founded the first Image Recovery Center 19 years ago at Baltimore's Union Memorial Hospital.
Salons throughout the world are offering more and more services tailored to those struggling with the effects of cancer. Hospitals are forming partnerships with local salons to serve their patients. Wig salons are tailoring their services.
The Look Good ... Feel Better program offers free monthly sessions in most Washington-area hospitals. The group sessions offer cancer patients beauty techniques, videos and online tips. The nationwide program has volunteer hairstylists, cosmetologists, wigmakers, etc., who make periodic appearances.
Kelly is a licensed cosmetologist, but she came to the idea of her program in a personal way. No stranger to cancer -- as a child she lost a sister to leukemia and then saw her own daughter develop the disease, from which she recovered -- Kelly learned that she had a brain tumor soon after her daughter fell ill.
After 15 hours of brain surgery, she awoke to face 18 frustrating months of rehabilitation, relearning how to walk and feed herself. It was the changes in her looks, however, that troubled Kelly the most.
"I had always been very particular about my appearance," Kelly said. Suddenly, she felt forced to find ways to cover her baldness and deal with the acne on her face.
"What I discovered was there was more to healing than medicine," Kelly said. "Feeling good about yourself played a very big role in my recovery."
That's how Kelly began to envision a one-stop shop to counter the disfiguring effects of medical treatments. She began by volunteering at Union Memorial in 1994, pushing her cart of cosmetics from room to room, offering free makeovers and talking to patients about the physical changes they were facing.
As time went on, her volunteering morphed into a business and she was providing a whole menu of patient-client services -- facials, wig cleaning and styling, eyebrow tinting -- at several Baltimore-area hospitals. In 2001, she opened an Image Recovery Center, as her business came to be known, at Johns Hopkins.
Seventeen such centers are operating in hospitals across the United States now. Three more are scheduled to open by the end of 2013. Kelly and her husband set up the facilities, designing the centers and hiring and training the staff. The centers offer shaving of the balding head, facials and manicures at prices comparable to those of moderately priced salons. They also sell custom-made wigs, hats, scarves and breast compression garments.
Kelly says she often hears clients say, "I can have cancer, and look this good?"
"Helping the patients to resolve some of the appearance issues that they're dealing with enhances the recovery, in that they feel positive. It helps their self-esteem," Kelly said.
There is another reason to keep up appearances during chemotherapy: An altered appearance can identify someone as a "person with cancer," according to Diana Harcourt and Hannah Frith in the July 2008 Journal of Health Psychology.
Debra Fruehling, the principal technical trainer at BAE Systems, was given a diagnosis of breast cancer in 2011. Since then, she has received dozens of chemotherapy and radiation treatments.
Fruehling, of Indian Head, Md., did not want some colleagues to know of her condition because she didn't want them to deal with her differently at work. Fruehling wanted a wig, but she refused to go to a normal wig shop because she didn't want to show her bald head. She went instead to the Image Recovery Center at Johns Hopkins.
"You don't know how it hurts to look in the mirror and see yourself bald," Fruehling, 47, said. "It's hard. And to know that all I got to do is grab this great-looking wig and put it on and I fixed that -- it takes stress away. And stress is the enemy to getting better."