On the day of a first chemotherapy infusion, some people arrive early in the morning and do not finish until evening. It is easy to feel uneasy and wonder why it takes so long, but a long day usually has a reason: several different medicines are given one after another rather than all at once.
In breast cancer and some other cancers, cytotoxic chemotherapy is sometimes combined with targeted therapy. Drugs such as docetaxel and carboplatin, together with the HER2-directed antibodies trastuzumab and pertuzumab, may be given in sequence on the same day. Each medicine has its own infusion rate and precautions, so the line is often flushed between drugs to keep them from mixing before moving on to the next one.
Before the main drugs, a set of preventive medicines called premedication is often given first. These can include anti-nausea medicines, an antihistamine to soften allergic reactions, and a steroid to reduce swelling and reactions. Because these are allowed to circulate before the main treatment begins, the overall day takes longer.
The first cycle in particular is frequently run slowly. Some targeted antibodies and chemotherapy drugs can cause an infusion reaction the first time they enter the body — chills, fever, facial flushing, or chest tightness — so the care team watches closely and adjusts the drip rate. By the second or third cycle, once it is clearer how the body responds, the pace may pick up a little.
The vein in the infused arm may feel achy or cold. For some drugs a warm compress can help, but for others warming is not advised, so it is best to ask the nurse before applying any heat. During one drug you may suddenly feel hot and sweaty, and during another you may feel chilled. Because body temperature can swing during the day, keeping both a light blanket and a fan (or a handheld fan) nearby makes it easier to adjust in the moment.
Because a lot of fluid is given, bathroom trips become frequent, so shoes that slip on and off easily and loose clothing help. It is usually a day without fasting, so light, easy-to-digest snacks and small sips of water spread out over the hours make the long stretch easier. Chargers, earphones, and something to watch or read help pass the time. If a companion comes along, it helps to know in advance whether there is a comfortable place to sit or lean.
During or after the infusion, tell the care team right away — without waiting it out — about numb or burning hands and feet, severe dizziness or shortness of breath, hives, or sudden chills with a high fever. When targeted antibodies are used, heart function is often checked periodically, so keeping your next appointment and test instructions handy can be reassuring.
This article is general information and does not replace an individual diagnosis or treatment. The medicines used, the infusion rate, and the precautions differ from person to person, so please discuss the specifics with your own care team.