Chemotherapy is a systemic treatment, meaning the drugs travel through the bloodstream to target rapidly dividing cells throughout the body. While the goal is to eliminate cancer cells, the treatment can also affect healthy cells, leading to side effects. Understanding the process and what to expect can help demystify the experience. This guide provides a clear roadmap for the logistical and physical aspects of your initial chemotherapy infusion.
Preparing for Your First Infusion Day
Preparation for your first infusion begins with optimizing your body’s readiness for treatment. A few days before your scheduled appointment, you will need to have blood work drawn to ensure your body is prepared for the chemotherapy dose. The oncology team checks your complete blood count (CBC) to confirm that white blood cell, red blood cell, and platelet levels are within a safe range. These laboratory checks also include a metabolic panel to assess kidney and liver function, as these organs process and eliminate the chemotherapy drugs.
Staying well-hydrated in the 24 hours leading up to your infusion is highly recommended. Adequate hydration increases blood volume, which makes veins more prominent and easier for the nurse to access. It also helps your kidneys begin the process of flushing the medications after they are administered.
On the day of treatment, aim to eat a light, bland meal two to three hours beforehand to help prevent nausea. Avoid heavy, greasy, or spicy foods that may be difficult to digest. You should also choose comfortable, loose-fitting clothing, such as a V-neck or button-down shirt, for easy access to your arm or chest port.
Since infusion sessions can vary in length, packing a small bag with items to keep you comfortable and occupied is helpful.
- Entertainment, such as a book or a tablet
- Headphones for listening to music or podcasts
- A water bottle
- A small, soft blanket or warm socks, as infusion rooms can be cool
Finally, arrange for a support person to drive you to and from the appointment. You may feel fatigued or drowsy afterward, especially on your first day.
What Happens During the Treatment Session
Once you arrive at the infusion center, the process begins with a check-in and an assessment by a nurse. The nurse will take your vital signs, including temperature, pulse, respiratory rate, and blood pressure, to establish a baseline. You will then be escorted to a comfortable reclining chair where a staff member will establish venous access. This is done either through a peripheral IV placed in your arm or by accessing a surgically implanted port catheter using a special non-coring needle.
After access is secured, the nurse will administer a series of pre-medications proactively to reduce the risk of side effects. These often include anti-nausea drugs, corticosteroids like dexamethasone, and sometimes an antihistamine such as diphenhydramine. The steroid prevents both acute and delayed nausea, while the antihistamine helps guard against potential infusion-related reactions (IRRs). You may notice immediate effects from these pre-meds, such as warmth, flushing, or drowsiness from the antihistamine.
There may be a brief waiting period while the pharmacy prepares your specific, individualized chemotherapy mixture. Once the drug is ready, the infusion begins, with the medication traveling from an IV bag directly into your bloodstream. The duration varies significantly, ranging from 30 minutes for some drugs to several hours for others. A typical first session lasts between one and six hours.
Throughout the infusion, the nursing staff will closely monitor you for any signs of an immediate infusion-related reaction. Symptoms of an IRR can include itching, a rash, shortness of breath, or sudden chills. The nurse will periodically check your vital signs. If a reaction occurs, the nurse is trained to immediately stop the infusion, administer supportive medications, and assess your condition. When the chemotherapy is complete, the line will be flushed with a saline solution, and the access needle or IV will be safely removed.
Navigating the Immediate Post-Treatment Period
The first 72 hours after your initial infusion are when the acute effects of chemotherapy are most likely to manifest. One of the most common side effects is fatigue, often described as an overwhelming exhaustion not relieved by sleep. To manage this, plan to rest when needed, but also incorporate short, gentle movement, such as a brief walk. This can help combat the deepest feelings of tiredness.
You may also experience “chemo brain,” a temporary cognitive impairment characterized by memory lapses or difficulty concentrating. Establishing a structured daily routine and relying on written notes or phone reminders can help manage this mental fogginess. Prioritizing consistent sleep is also beneficial, as fatigue exacerbates cognitive symptoms.
Managing nausea is primary, and your oncology team will prescribe anti-nausea medications, known as antiemetics, which must be taken proactively. It is effective to take these medications on a scheduled basis for the first two to three days, even if you do not feel sick. Waiting until nausea is severe makes it much harder to control, especially since delayed nausea can appear more than 24 hours after the infusion.
Hydration and diet remain important during this time to help your body recover and process the drugs. Continue to consume eight to ten glasses of caffeine-free fluids each day, choosing options like water, clear broths, or electrolyte drinks. Food intake should focus on small, frequent meals, aiming for five to six smaller portions of bland, low-fat foods rather than three large meals. Avoiding strong-smelling, fried, or highly acidic foods can help prevent an upset stomach.
You must remain vigilant for specific safety signs, as chemotherapy temporarily lowers your white blood cell count, compromising your immune system. The most pressing sign requiring immediate action is a fever. Contact your oncology team immediately, day or night, if you have a temperature of 100.4°F (38°C) or higher, or if you experience uncontrollable shaking chills. This fever threshold indicates a potential infection and must be addressed swiftly. Severe vomiting that prevents you from keeping fluids down, or signs of uncontrolled bleeding, also warrant an immediate call.