What to Expect at Your First Chemotherapy Session

Walking into your first chemotherapy session can feel like a big unknown. Knowing the basic shape of the day helps. That means how the medicine is given, where you will be, and what your team is watching for.

Chemotherapy can be given in several ways, and your care team will tell you which applies to you:

• By mouth, as a pill or liquid.
• Intravenously (IV), into a vein — this is the most common way. IV chemotherapy may go through a thin needle in a vein in your hand or lower arm. It may also go through a catheter or a port, sometimes with the help of a pump.
• By injection, or through other routes your doctor will explain.

If you already have a port or catheter placed, your session will use that instead of a new needle stick in your arm each time.

You may receive chemotherapy in a hospital or at home. You may also get it as an outpatient, meaning you do not stay overnight, at a doctor's office, clinic, or hospital. Your care team will let you know ahead of time where to go and what to bring.

If you are getting IV chemotherapy, a nurse puts the needle in at the start of your session. It stays in for as long as that visit's treatment takes. The nurse removes it once you are finished. Through the session, your doctor and nurse watch for side effects. They are ready to help if something comes up.

Chemotherapy is often given in cycles — a period of treatment followed by a period of rest. For example, you might get chemotherapy for one week and then have three weeks off before the next round. Your first session starts that pattern. Your team will explain what your own schedule looks like.

Everyone responds differently to chemotherapy, so your team cannot say for certain how you personally will feel. The most common side effect is fatigue — feeling unusually tired or worn out. Because of this, it helps to plan ahead:

• Arrange a ride to and from your session, rather than planning to drive yourself.
• Set aside time to rest on the day of treatment and the day after.
• Ask someone to help with errands, meals, or childcare if you can.

It is natural to look for clues about whether the treatment is doing its job. Even so, you cannot tell whether chemotherapy is working from how you feel. Side effects, or the lack of them, do not show how well the treatment is working. Your care team checks progress over time with exams and tests, not with how rough or fine you feel after a session.

Before your first session, ask your care team how your chemotherapy will be given. Ask where it will happen, and roughly how long to expect to be there. Bring a list of questions with you — there is no such thing as asking too much when you are just getting started.

• Call 911 or go to an emergency department if you have trouble breathing, wheezing, chest tightness, or swelling of the face, lips or tongue during your infusion or after you get home. These can be signs of a severe reaction to the drug. Tell your infusion nurse right away if it starts while you are still in the chair. Do not drive yourself.
• Call your care team right away, day or night, if you run a temperature of 100.4°F (38°C) or higher, get shaking chills, or feel hot and shivery in the days after your first session. Call right away too for chills, a sore throat, mouth sores or burning when you urinate, even with a normal temperature. According to CDC, a fever on chemotherapy is an emergency, and infection can be life threatening. Use the number your team gave you. If no one answers quickly, go to an emergency department and say you are having chemotherapy.
• Call your care team right away, day or night, if the spot where the IV needle or port went in becomes sore, swollen, red, warm, or starts leaking fluid. NCI says to watch for signs of infection around a port or catheter.
• Call 911 or go to the nearest emergency department if tiredness comes with trouble breathing, chest pain or a pounding heartbeat, or if you have black or tarry stool, vomit blood or material that looks like coffee grounds, have bleeding that will not stop, suddenly cannot urinate at all, or are suddenly confused or hard to wake. Do not drive yourself.

Sources: Infection and Neutropenia During Cancer Treatment (NCI); Anaphylaxis (MedlinePlus); Anemia and Cancer Treatment (NCI); Fever During Chemotherapy (CDC)