Starting chemotherapy can be an anxious and uncertain time for cancer patients. While every person reacts differently, most patients experience some side effects from their very first chemo treatment. Knowing what to expect can help ease some of the anxiety around beginning this new phase of cancer treatment.
What happens during the first chemo session?
The first chemotherapy session is often the longest, taking 4-8 hours or more. This extended time allows for:
- Meeting the oncology team
- Having an IV catheter inserted
- Receiving pre-medication drugs
- The chemotherapy infusion
- Observation and recovery time
Patients meet with their oncologist and chemotherapy nurses at the start of the appointment. The medical team explains the treatment plan, chemotherapy drugs, and potential side effects. Patients have an opportunity to ask questions before starting treatment.
An IV catheter, often called a port, is placed in a vein in the arm or chest. This provides access to give chemotherapy drugs and other medications intravenously. Placement of the port can take 30-60 minutes.
Pre-medication drugs are given through the IV before chemotherapy starts. These help prevent side effects like nausea, vomiting, inflammation, and allergic reactions. Common pre-meds include steroids, anti-nausea medication, Benadryl, and Tylenol.
Next comes the actual chemotherapy infusion. How long this takes depends on the specific drugs being used. The first treatment generally infuses for 2-4 hours.
Patients are monitored during and after chemo administration. Vital signs are checked and nurses ask about any reactions or side effects. Many infusion centers have recliners for comfort during long treatments.
Before leaving, patients receive instructions on medications, diet, activity, and what to watch out for. A plan is made for follow up and the next chemo session. First infusions often end with a sense of relief at having started treatment.
Common physical side effects
While not everyone has symptoms from their first chemo, most patients experience some physical side effects. The most common include:
- Fatigue – A deep tiredness that can range from mild to severe. Fatigue often increases over successive treatments.
- Nausea and vomiting – Chemotherapy drugs irritate the stomach lining causing nausea. Vomiting can result. Meds given before chemo help prevent this.
- Hair loss – Some chemo drugs damage rapidly dividing hair cells causing hair to fall out. Hair loss usually starts after the first few sessions.
- Constipation – Some chemo drugs cause constipation by slowing digestion. Staying hydrated and active can help minimize this.
- Diarrhea – Certain chemo medications loosen stool and speed up digestion resulting in diarrhea.
- Headache – Caused by sudden fluid shifts after treatment. Headaches tend to resolve in a day or two.
- Mouth sores – Damage to the mouth lining can cause painful sores. Good oral care minimizes this.
While concerning, most of these side effects are temporary and manageable with medication. Let your oncology team know if any symptoms persist or interfere with daily activities.
Emotional reactions
In addition to physical side effects, patients often have strong emotional reactions to their first chemotherapy session. Starting treatment triggers a roller coaster of emotions including:
- Anxiety – It’s normal to feel apprehensive about chemotherapy drugs and procedures. Fears of side effects and the unknown are common.
- Sadness – Chemotherapy may represent a loss of health or independence. Processing these losses often brings grief and tears.
- Anger – Frustration about having cancer and needing chemo is expected. Anger often ebbs and flows throughout treatment.
- Loneliness – Treatment can feel isolating. Connecting with others helps overcome feelings of loneliness.
- Hope – Starting active treatment also fosters hope and optimism about beating cancer.
- Relief – Finally taking action against cancer brings relief and a sense of empowerment.
Mood swings and emotional reactivity are common during chemotherapy. Give yourself grace throughout the ups and downs.
Tips for the first session
These tips help patients have the best experience possible for their first chemo treatment:
- Learn about your chemo drugs – Ask your care team how each medication works and potential effects.
- Arrange transportation – Don’t try to drive yourself home after the first treatment.
- Have a companion – Bring a friend or family member to provide support.
- Wear comfortable clothes – Choose loose, soft fabrics since you may have IV lines and be sitting for hours.
- Pack a blanket and entertainment – Help pass the time during long infusions.
- Bring food and drink – Hospitals can have limited cafeteria options.
- Take medications as prescribed – Prevent nausea, pain, constipation, etc. Don’t try to “tough it out”.
- Rest after chemo – Save chores and errands for another day.
- Start a journal – Note symptoms and side effects to discuss with your oncology team.
- Stay hydrated – Drink plenty of fluids to flush chemotherapy drugs from your system.
While chemo may seem scary, being prepared helps ease anxiety around starting treatment. The first session gets easier as patients know what to expect.
When side effects start
Most physical side effects don’t start immediately during the first chemo treatment, but develop gradually over hours or days. Here’s the typical timing of common side effects:
| Side Effect | Onset |
|---|---|
| Fatigue | 2 to 10 days after infusion |
| Nausea | 2 to 4 hours after chemo |
| Vomiting | 4 to 24 hours after chemo |
| Hair loss | 2 to 3 weeks after first treatment |
| Constipation | 2 to 4 days after chemo |
| Diarrhea | A few hours or days after chemo |
| Headache | A few hours after infusion |
| Mouth sores | 5 to 10 days after chemo starts |
Keep track of when side effects start and report them to your medical team. This helps determine if medication adjustments are needed.
Coping strategies
Dealing with the emotions and physical side effects of chemo is challenging. Here are some healthy coping strategies:
- Talk to supportive friends and family – Don’t isolate yourself, share what you’re going through.
- Join a support group – Connect with other patients who understand your experience.
- Explore complementary therapies – Acupuncture, massage, and nature walks can be calming.
- Engage in creative activities – Crafts, music, and art help distract from symptoms.
- Find comforting objects or routines – Items like soft blankets or favorite shows establish a sense of normalcy.
- Practice meditation and deep breathing – Quiet the mind and relax the body to manage stress.
- Focus on nutrition – Eat small, bland meals on chemo days to settle your stomach.
- Balance rest and activity – Alternate periods of rest with gentle walking to boost energy.
- Plan enjoyable activities – Schedule things like manicures or movies to anticipate.
Cancer patients don’t have to cope with chemo alone. Reach out for physical, emotional and mental support.
Long term side effects
While most initial side effects resolve after each chemo cycle ends, some can linger longer term. Ongoing effects may include:
- Fatigue – Extreme tiredness can persist for weeks or months after chemotherapy ends.
- Nerve damage – Some chemo agents injure peripheral nerves causing numbness or tingling in hands and feet.
- Memory problems – Chemotherapy can impair cognition, especially short-term memory.
- Muscle weakness – Lack of activity and nerve damage might cause persistent weakness.
- Weight gain – Steroids plus reduced activity can lead to extra pounds.
- Early menopause – Chemo may permanently damage ovaries causing menopause symptoms.
- Bone loss – Reduced estrogen from chemo causes bone weakening osteoporosis.
Stay in contact with your oncology team after chemotherapy ends. Report any ongoing side effects or concerns. Additional medications or therapies may ease lingering chemo side effects.
Conclusion
The first chemotherapy session marks the beginning of a challenging, but hopefully life-saving treatment journey. Being prepared by learning about the process, potential side effects, and coping strategies enables patients to have the best experience possible.
Every person responds differently to chemotherapy drugs. Stay in tune with your body and speak up about any side effects or emotional needs. Additional medications and support can make chemotherapy more tolerable.
Focus on the positives – you are actively fighting cancer. Allow yourself moments of hope, optimism and even celebration. Take things one chemo session at a time and trust your care team to guide you through this experience as comfortably as possible.