What to expect with my first chemotherapy cycle

Dr Sarita Retief explains what to expect when you go for your first chemotherapy cycle.

If there is one thing that COVID-19 has taught us all, is that it is very difficult to deal with an unknown future. And that is what everyone must go through at the start of chemotherapy.

The day before anxiety creeps up and the night before you can hardly sleep. On the day that you start treatment, you are already emotionally exhausted. But then, after going through the first cycle, most people find that it was not nearly as bad as what they thought it would be.

Three-weekly chemotherapy cycle

So, here is more or less what to expect, based on a three-weekly cycle. Most chemotherapy is given like that. Several tips have been included to help you.

Day 1

On the first day, you find that none of the things you feared, came true.  You go to the doctor, have a drip, meet new people. And, then nothing!

With the drip, you will first have medication to prevent an allergic reaction (for some chemotherapies), followed by medication to prevent nausea.  Then the chemotherapy will be given. The duration of the infusion will depend on the type of chemotherapy and can be anything from 30 minutes to eight hours.

If you feel any burning sensation at the site of the drip/port site, or in the vein of that arm, you need to tell the nursing staff immediately. It is very important that the chemotherapy does not leak into your tissues.

The nursing staff will also be checking continually if you have any symptoms or signs of an allergic reaction to the chemotherapy. If you have a reaction, they will stop the drip and give appropriate medication. After a while, you usually will be ready again to continue the infusion.

The afternoon after the chemotherapy, you may have a slight headache or constipation. These are side effects of the nausea medication given.

Tips

• Make sure that you eat your normal breakfast and drink your chronic medication.
• Drink a lot of water.
• Stay moderately active.

Day 2-5

Most people will feel the effects of treatment during the afternoon of the second day. You might feel fatigued and a loss of appetite. During these days, it is very important to prevent nausea.

With modern anti-nausea medication, it’s totally possible for most people not to feel any degree of nausea. The anti-nausea medications that you get in your drip on the first day, can prevent nausea for up to five days after the chemo. Sometimes this is not enough, and you might need further oral medication.

You usually will be given:

• Nausea tablets for slight nausea that you will start at the first sign of any nausea.
• Stronger nausea tablets that you can drink/melt under your tongue if the first ones are not enough.
• A certain drug, olanzapine, has been found to also makes a huge difference if used at 5mg every night for the first few days.
• If you are prone to peptic ulcer disease, it is also recommended to use an anti-acid every day throughout the treatment.

Tips

• Keep taking lots of fluids, be moderately active, eat small meals often.
• Take your nausea medication if you feel any degree of nausea. In most cases when people suffer from nausea, it is because they did not take their medication.
• If the given medication does not relieve nausea, contact your treating doctor. It is vital to break the nausea cycle quickly, otherwise it can also develop a psychological component.

Specific chemotherapy drugs can have specific side effects during this period. Oxaliplatin can cause an electric shock feeling when you touch something cold, or drink cold fluids. Paclitaxel can cause pain in the limbs from day 3-5 of the first cycle.

Day 6-14

This is the period that you should start feeling better each day. This is also the most important time for the oncologist, because it is the time that you can have bone marrow suppression.

This might lead to anaemia (feeling fatigued, dizziness), low white cells (sores in your mouth, diarrhoea) and low platelets (easy bruising, bleeding gums).

Secondary to the low white cell count, you are prone to infections, that can cause further diarrhoea, coughing, fever and thrush in your mouth.

Tips

• If you have any of the above symptoms, it is imperative to contact your treating doctor. You can get seriously ill if you delay treatment.

Day 14-21

This is the week where you should almost feel normal again. Unfortunately, this is also the time that you will experience hair loss (for specific chemotherapies). Even if you prepare yourself for it, emotionally it is a dark hour when you realise that your hair is starting to fall out. It is almost only then that you really comprehend that you have started chemotherapy.

Tips

• You can prepare yourself for hair loss by cutting your hair shorter at about day 9.
• Decide beforehand if you want to wear a wig or just a bandana or hoodie. Have fun.
• Know that the hair will grow back after chemotherapy is completed. Most people like their new hair much more. It’s usually thicker and has more texture. It’s also a great time to go funky grey (if you have been colouring your hair).

Never suffer in silence

The first chemotherapy cycle is the time to see what specific side effects you experienced. Remember, for all the problems that you might have, there is a solution. Never suffer in silence. Ask for help.  Following sessions are usually easier, because you know what to expect. Even if it seems that there is a huge mountain ahead of you, just know that time passes very quickly. Before you know it, you have finished all your chemo sessions.