Key points
- Write down your questions before the first session and bring someone close to you to help you listen and remember what is said [1].
- See a dentist at least two weeks before you start so that any dental work can be done before treatment [1].
- If you may want children in the future, say so before the first session; the earlier this is raised, the more options remain to preserve fertility [7].
- During the infusion, tell the nurse straight away about anything unusual: pain or burning where the needle is, flushing, itching, shortness of breath or a pounding heart [1, 4].
- A temperature of 38 °C or higher in the days after chemotherapy is an emergency; call your treatment team before taking any medicine for fever [2].
Before your first session: what should I do?
Getting ready in the days before
- 1
Write down your questions
Some important questions: What is the aim of this treatment? How many cycles, and how often? How will the medicines be given, and how long will each session take? Which side effects come early and which come later? When should I call? Should someone take me to the session and bring me home? [1]
Ask whom to call at night and at weekends, and save that number in your phone [1].
- 2
Blood tests
Blood tests are done before treatment cycles to check your blood cell counts [1]. A hepatitis B test is also recommended before you start. This virus can sit quietly in the body and become active again during treatment. If the test is positive, an antiviral medicine keeps it from becoming active. Starting cancer treatment should not be delayed because of this test [6].
- 3
Dental check
See a dentist at least two weeks before you start, so that your mouth is as healthy as possible and any dental work is done before treatment. Tell the dentist that you are about to have chemotherapy. If there is no time, ask when it is safe to see a dentist during treatment [1]. For mouth care, see Mouth sores (mucositis).
- 4
Fertility and pregnancy
If you might want children in the future, tell your doctor now. Freezing sperm, eggs or embryos are established methods, and the earlier this is discussed, the more options remain [7].
Chemotherapy may harm an unborn baby. Avoid pregnancy during treatment. If you still have periods, you may be asked to have a pregnancy test before you start [1]. Read more: Fertility and sex during cancer treatment.
- 5
List of medicines and supplements
Tell your doctor about all your medicines, even painkillers, laxatives, allergy and cold medicines, vitamins and supplements. The easiest way is to bring the packets themselves. Some supplements can change how chemotherapy works; during treatment, do not start anything new without asking first [1].
- 6
What should I bring?
Documents and lists
Your medical records and latest test results, your list of medicines (or the packets themselves) and your list of questions [1].
Comfortable clothes
Loose clothes in layers. If you have a port, wear something that makes it easy to uncover the upper chest.
A light snack
Some people feel better after a light meal before the session, others on an empty stomach (nothing to eat for 2 to 3 hours before). After the session, wait at least an hour before you eat or drink [1].
Something to pass the time
A book, music with headphones or a charged phone. Some medicines take several hours to infuse; paclitaxel, for example, is often given over 3 hours [4].
Contact numbers
Save the numbers of the ward, your doctor and the night and weekend line in your phone, and know where to go in an emergency [1].
Treatment day: what happens?
Infusion into a vein: most chemotherapy is given through a thin needle in a vein in the hand or forearm. The nurse puts the needle in at the start of the session and takes it out at the end. The medicine may instead be given through a port or catheter, and sometimes a small portable pump carries on the infusion at home [1].
Medicines before chemotherapy: an anti-sickness medicine is usually given about an hour before chemotherapy [1]. For some drugs, such as paclitaxel, a steroid and an anti-allergy medicine are also needed before the infusion to prevent an allergic reaction [4]. Before every rituximab infusion, paracetamol (acetaminophen) and an anti-allergy medicine are given as well [5].
The first session may take longer: some drugs, such as rituximab, are started more slowly at the first infusion and the rate is raised step by step [5]. How long the session lasts depends on your medicines; ask beforehand [1].
Under the nurse's eye: throughout the session, the doctor and nurse watch for side effects. If you feel pain or burning where the needle is during the infusion, say so straight away [1].
Sometimes the body reacts to a medicine. With some drugs, such as rituximab, severe reactions mostly happen at the first infusion, usually half an hour to two hours after it starts [5]. If you notice any of the following, call the nurse at once:
- Flushing, itching or hives [4, 5]
- Shortness of breath or wheezing [4, 5]
- A pounding heart or dizziness (your blood pressure may have dropped) [4]
- Swelling of the lips, tongue or face [4, 5]
- Pain, burning or swelling where the needle is [1]
The team is prepared for this: depending on how severe the reaction is, the infusion continues or is stopped at once and the necessary treatment is given [4].
After the session: the first days at home
- 1
Take your anti-sickness medicines on schedule
Nausea can start during the session, soon after, or hours to days later. Take your anti-sickness medicines on schedule for the few days after the session. If they do not work, tell your doctor so that a different medicine can be prescribed [1]. Full guide: Nausea and vomiting during cancer treatment.
- 2
Check your temperature
Keep a digital thermometer at home and check your temperature at least once a day, or as often as your team tells you [1]. Report a temperature of 38 °C or higher straight away. Do not take fever medicines before you call, not even paracetamol or ibuprofen, because they can hide the signs of an infection [2].
- 3
Prevent infection
Wash your hands often with soap and water. Stay away from people who are ill and from crowds. Cook meat, chicken, fish and eggs thoroughly, and wash fruit and vegetables well [1]. Read more: Low blood counts and preventing infection.
- 4
Look after your mouth
Brush with a very soft toothbrush after every meal and before bed, use an alcohol-free mouthwash, and check your mouth every day for sores or white patches [1].
- 5
Take care with body fluids
After chemotherapy, you and your family need to avoid contact with your body fluids (urine, stools, vomit, blood) for a while: close the toilet lid and flush twice, sit down to pass urine, wash your hands with soap and water, wear gloves to clean up body fluids, wash soiled sheets and clothes separately, and use condoms during sex. Ask your team how long to do this [1].
- 6
Rest and some activity
Tiredness is common. Sleep at least 8 hours a night, take short rests and share tasks with others. Light walking, for example for 15 minutes, helps ease tiredness [1]. Read more: Fatigue from cancer and its treatment.
Checklist for your first session
| When | What to do |
|---|---|
| At least two weeks before | Dental check and any dental work needed [1] |
| Before you start | Talk about preserving fertility and avoiding pregnancy [1, 7]; blood tests and a hepatitis B test [1, 6] |
| The day before | Write down your questions, prepare your list of medicines, arrange company and transport [1] |
| Treatment day | A light meal or an empty stomach (whichever suits you), comfortable clothes, something to pass the time, report any burning or reaction at once [1] |
| The days after | Take anti-sickness medicines on schedule, check your temperature daily, wash your hands and cook food thoroughly [1] |
| At all times | Night and weekend number in your phone; report a temperature of 38 °C or higher straight away [1, 2] |
When should I contact a doctor?
Call your treatment team straight away or go to the emergency department if:
- You have a temperature of 38 °C or higher, even if you feel well. In hospital, antibiotics should be started within one hour [2, 3].
- You have chills or sweats, a cough, a sore throat, burning or frequent urination, earache, a headache or a stiff neck [1, 2].
- The skin around your port or catheter is red, swollen or painful, or there is discharge [1].
- You have been vomiting for more than a day, or you bring back everything you drink [1].
- Diarrhoea has lasted more than 24 hours or comes with pain and cramps [1].
Night-time or a weekend is no reason to wait [1]. If you suddenly feel very unwell, for example with severe shortness of breath or confusion, call your local emergency number.
Frequently asked questions
Does the first chemotherapy session hurt?
Can I drive myself home after the session?
Ask your treatment team about this beforehand [1]. If you are not sure, arrange for someone to come back with you.
If I have no side effects, does it mean the chemotherapy is not working?
Can I work during chemotherapy?
Many patients can work, as long as they fit their work schedule to how they feel, for example working less or from home on harder days [1]. Read more: Returning to work and daily life.
I feel fine; should I still take the anti-sickness medicines?
Yes, on schedule. Anti-sickness medicine is given before the session and for a few days afterwards, because nausea can start hours or days later [1]. Read more: Nausea and vomiting during cancer treatment.
Is my family at risk?
A few simple steps protect them: for a while, your family should avoid contact with your body fluids (urine, stools, vomit, blood), wear gloves to clean them up and wash their hands afterwards. How long depends on your medicines and on your treatment centre's instructions [1].
Related pages
Before starting chemotherapy (for doctors)
Show detailsHide
- Hepatitis B (ASCO 2020): before any systemic anticancer therapy, three tests: HBsAg, anti-HBc (total Ig or IgG) and anti-HBs; anticancer therapy should not be delayed for this. In chronic HBV (HBsAg positive) with any systemic therapy, antiviral prophylaxis during treatment and for at least 12 months afterwards. In past infection (HBsAg negative, anti-HBc positive) with high-risk therapy such as anti-CD20 antibodies or stem cell transplantation, prophylaxis during treatment and for at least 12 months afterwards, or careful monitoring where frequent, consistent follow-up is possible. Hormonal therapy alone poses no substantial risk [6]. Details: Hepatitis B and chemotherapy.
- Fertility (ASCO 2018): discuss the risk of infertility with patients of reproductive age as early as possible and document it; refer to a reproductive specialist. Sperm, oocyte and embryo cryopreservation are standard practice; GnRHa should not replace proven methods [7]. Fertility preservation before cancer treatment.
- Capecitabine (FDA label, revised 10/2025): before starting, test for DPYD gene variants unless immediate treatment is necessary; avoid the drug in complete DPD deficiency, and the absence of a variant does not rule out severe toxicity [8]. DPYD and UGT1A1 testing.
- Paclitaxel premedication (FDA label): dexamethasone 20 mg orally about 12 and 6 hours before the drug, diphenhydramine (or equivalent) 50 mg IV, and cimetidine 300 mg or ranitidine 50 mg IV, 30 to 60 minutes before the drug. Anaphylaxis and severe hypersensitivity occurred in 2 to 4% of patients in clinical trials, and fatal reactions have occurred despite premedication. Minor symptoms (flushing, skin reactions, dyspnoea, hypotension or tachycardia) do not require interruption; a severe reaction requires immediate discontinuation and symptomatic treatment, and the drug is not given again [4].
- Rituximab (FDA label): paracetamol (acetaminophen) and an antihistamine before every infusion. First infusion at 50 mg/h; in the absence of a reaction, increase by 50 mg/h every 30 minutes to a maximum of 400 mg/h. Severe reactions typically occur at the first infusion, with onset at 30 to 120 minutes; about 80% of fatal reactions occurred with the first infusion. Before the first dose, screen HBsAg and anti-HBc and obtain a complete blood count with platelets [5]. Managing reactions: Infusion reactions and desensitisation.
- Fever and neutropenia (ASCO/IDSA 2018): first dose of empirical antibiotic within one hour of triage and monitoring for at least 4 hours before discharge; select outpatients by clinical judgement or a validated tool such as the MASCC score [3]. See also: Fever and neutropenia and choosing an antiemetic regimen.
References
8 referencesShow all references, 2 with a study cardClose the reference list
Numbers in the text, such as [1], refer to these sources. Sources with a “Study card” button are summarised in the site’s evidence library.
- 1
- 2
- 3Outpatient Management of Fever and Neutropenia in Adults Treated for Malignancy: American Society of Clinical Oncology and Infectious Diseases Society of America Clinical Practice Guideline Update
- 4
- 5
- 6
- 7
- 8XELODA (capecitabine) tablets, for oral use — Prescribing Information
This page is based on reputable scientific sources and was last updated on 28 October 2026. The content of this website is for educational and informational purposes only and does not replace consultation, diagnosis or treatment by a specialist physician. Consult your treating physician about any treatment decision.
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