What to Do Before Your Chemo Infusion: A Checklist From People Who've Been There

A chemotherapy start date can arrive fast. Between scans, appointments and insurance calls, there's often little time to think about what daily life during treatment will actually look like, or which decisions need to be made before the first infusion.

CURE has talked with many survivors and experts about exactly that moment. Here's what they've learned and what they want newly diagnosed patients to know.

1. Decide about your hair before treatment starts

For many patients, losing their hair is one of the hardest parts of chemotherapy. When Maureen Green was diagnosed with breast cancer at 34, her oncologist told her she would lose all her hair after the first infusion. Green told CURE in a conversation about her scalp cooling experience that the moment was especially difficult. She worried she wouldn't be able to take her daughter to the playground and feel like a normal person, and that everyone would know she was sick.

The good news is that patients have options. The catch is that most of them have to start before chemotherapy does.

Preserving your own hair

Deborah A. McDowell has spent more than a decade helping women hold onto their hair, and their sense of self, through treatment. In a CURE video interview, the founder of Oncology Aesthetics & Wellness (OAW) described a process she calls CPR, short for cut, preserve and reattach.

Before chemotherapy begins, a patient's own hair is cut and made into a wig. Once her natural hair grows back to about half an inch, the same hair can be turned into extensions. About a year later, when her hair reaches roughly bob length, it can become clip-ins. Some women instead have their hair made into a halo or hair hat, and some later donate their preserved hair to another patient.

McDowell said too many women don't learn this is an option until chemotherapy has already started or ended, when they may have shaved or donated their hair. Knowing ahead of time gives them a chance to decide.

"It's not vanity; it's your identity," she said. A woman may not feel her best during treatment, she explained, but she can still look in the mirror and see herself.

OAW offers free virtual and phone consultations. McDowell said cost varies, and payment plans and financial assistance may be available in some cases.

Trying scalp cooling

Scalp cooling, often called cold capping, cools the scalp during chemotherapy to reduce how much of the drug reaches hair follicles. Dr. Stephen Kimani, a breast medical oncologist at the University of Utah's Huntsman Cancer Institute, explained to CURE that lowering blood flow to the scalp protects those fast-dividing cells. That can mean less hair loss, or quicker regrowth once treatment ends.

Timing matters. Dr. Julie Nangia, a breast cancer specialist at Baylor College of Medicine who led a major scalp cooling trial, told CURE that patients need to start with their very first infusion, since hair can fall out after just one treatment. She said the cap is typically worn at least 30 minutes before each infusion, possibly 45 minutes for people with very thick hair. It stays on through the infusion and for 30 to 90 minutes afterward, depending on the drug.

How well does it work? It depends largely on your chemotherapy. Kimani said results are strongest for patients receiving taxane-based chemotherapy without an anthracycline, and much weaker with anthracycline regimens. Nangia shared similar findings. She also noted that fit matters: gaps between the cap and scalp can lead to hair loss in those spots, so she recommends avoiding braids, weaves and extensions during treatment.

Even with scalp cooling, Kimani emphasized, some hair loss usually still happens, just less of it.

Who shouldn't use it? Kimani told CURE that scalp cooling generally isn't recommended for people with blood cancers like leukemia or lymphoma, since cancer cells may be circulating in the blood. It may also not suit people getting radiation for brain tumors, or those whose infusions run 24 hours or longer.

What's it like? Green said scalp cooling added a lot of time to each treatment and was uncomfortable, but for her it was worth it. Nangia said most patients in her study found the caps comfortable. The most common complaints were feeling cold, claustrophobic or uncomfortable, and some people with migraine history struggled with cold-induced headaches.

What about cost? For years, cost was a major barrier. Green said scalp cooling wasn't covered by her insurance, and she and her family had to weigh it against other expenses, including fertility treatment. She later shared her story with New York lawmakers. The state has since passed a law requiring large private insurance plans to cover scalp cooling, effective Jan. 1, 2026.

Other options are emerging, too. CURE has reported on the Paxman Scalp Cooling System's approval for patients with solid tumors. CURE has also covered Amma, a newer at-home cooling cap developed by a breast cancer survivor, which can be rented at a lower cost.

Ask your team: Does my center offer scalp cooling? Will it work with my regimen? Will my insurance cover it?

Don't forget eyebrows

Chemotherapy can affect more than the hair on your head. McDowell suggests patients who are concerned look into options like eyebrow microblading before treatment begins.

2. Get your skin ready

Chemotherapy can affect the skin, too. McDowell encourages patients to stay hydrated throughout treatment for that reason.

Some drugs can also cause hand-foot syndrome, a reaction that brings redness, swelling and blistering on the palms and soles. Dr. Namrata "Neena" Vijayvergia, assistant chief of gastrointestinal medical oncology at Fox Chase Cancer Center in Philadelphia, walked CURE through how hand-foot syndrome develops with the oral chemotherapy Xeloda (capecitabine), which is used for breast and gastrointestinal cancers.

She explained that it can make skin on the hands and feet very dry and thick, and eventually cause peeling. In more severe cases, it can make it painful to open bottles or walk comfortably.

Prevention starts on day one. "Moisturizing is key," Vijayvergia said. She recommends urea-based creams every morning and night. Before bed, she tells patients to apply a thick layer to their hands and feet, then sleep in cotton gloves and cotton socks to lock in moisture.

Speak up early. Vijayvergia stressed the importance of catching hand-foot syndrome while it's mild. If it progresses, it can seriously affect quality of life. With Xeloda, she said, the main treatment is holding or lowering the dose until the skin heals, then slowly building back up.

Ask your team: Can my regimen cause skin or hand-foot changes? Which moisturizer do you recommend?

3. Ask about protecting your hands and feet from nerve damage

Some chemotherapy drugs can damage nerves in the hands and feet, causing tingling, numbness or pain that makes it hard to button a shirt, write or walk. This is called chemotherapy-induced peripheral neuropathy.

CURE has covered early research on cold compression to help prevent neuropathy. In a small study, mostly of patients with ovarian cancer, researchers at Duke University Medical Center combined compression socks, tight surgical gloves and ice packs on one hand and foot during infusions. Symptoms tended to be better on the treated side, and most patients said they would use it again.

The research is still early, but if your regimen is known to cause neuropathy, it's worth asking your team what they recommend.

4. Take it one day at a time

Brad Moore was diagnosed with stage 3 rectal cancer in 2021. He went through chemoradiation, surgery, chemotherapy and a temporary ileostomy, and has had no evidence of disease since finishing treatment.

In CURE's "Text a Survivor" series, Moore said it was hard to grasp in those first weeks what treatment would actually feel like. What helped was focusing only on what he could manage, one day at a time. He also described the mental hurdle of his first days with an ileostomy, and how building a routine made it more manageable.

Green offered similar advice to newly diagnosed patients. She said to take things one step at a time, and to both accept help when it's offered and ask for it when you need it.

5. Build your support team

Sally Kalksma has lived with multiple myeloma for 18 years, and she's clear that medicine alone didn't get her through it. In CURE's video series "10 Things That Got Me Through Treatment", she credits her three children, her four sisters, her oncologist and a "cancer care buddy" with carrying her through. Kalksma hopes her story encourages others to find their own sources of support, motivation and joy.

Of course, support looks different for everyone. It might be a large family, one close friend or a trusted nurse. What matters is having people you can lean on and letting them know how they can help.

And sometimes, support doesn't come on two legs at all. April Floyd faced breast, kidney and ovarian cancer, and at one point was placed on hospice and told she might have four to eight months to live. In a CURE blog about her service dog, Onyx, she described how the Goldendoodle she adopted from a shelter stayed beside her through it all. Alongside her husband, family and medical team, Onyx gave her companionship, routine and a reason to keep moving forward. Floyd's advice to others facing cancer is to hold on to whatever gives you a reason to keep going, whether that's a person, a purpose or a pet.

Before chemo, consider:

• Choosing a treatment buddy to come to infusions and help keep track of information
• Picking one person to share updates with friends and family, so you don't have to repeat the news
• Writing down who has offered help and what each person is good at

McDowell also said OAW connects women with others who've had the same cancer or treatment, giving them a place to talk about parts of the experience that may not come up with their medical team.

6. Set goals beyond cancer

Kalksma also found strength in goals outside of treatment: running, stair climbing, journaling and time on her boat. Her message is that the things that help can come from unexpected places.

If you want to stay active, CURE's video with Jennifer Tipton walks through gentle exercises to keep you moving during treatment, focused on strength, mobility and balance. Check with your care team before starting any exercise routine.

Staying active can also help protect your strength during treatment, and it's worth planning for before chemo begins. Leslie Waltke, a physical therapist, founder of the Waltke Cancer Rehabilitation Academy and member of CURE's advisory board, told CURE that physical therapy should begin at the time of a cancer diagnosis. Treatments like chemotherapy can affect energy, balance, strength and range of motion, and starting early can help minimize or even prevent those problems. "We don't wait for people to have more and more problems before we initiate care," Waltke said. Ask your care team for a referral to a physical therapist who works with people with cancer, and check with them before starting any exercise routine.

7. Know that recovery takes time

Treatment ending doesn't always mean side effects end. Moore still manages long-term effects, including neuropathy and bowel changes after surgery. He said one of the hardest parts is talking with people who assume life goes back to normal once treatment is over.

Knowing that ahead of time can make the road after chemo feel less surprising, and make it easier to ask for the support you still need.

Quick checklist before your first infusion

• Ask whether hair preservation or scalp cooling is right for you, and arrange it before treatment
• Check whether your insurance covers scalp cooling
• Ask whether your regimen can cause hand-foot syndrome or neuropathy
• Stock up on urea-based cream, cotton gloves and cotton socks
• Plan to stay hydrated
• Choose a treatment buddy and an update person
• Set one goal that isn't about cancer
• Remember: one day at a time

There's no way to know exactly what chemotherapy will feel like until you're in it, but the people who have been there agree that you don't have to walk in unprepared or alone. Whether it's saving your hair, moisturizing your hands before bed, leaning on a trusted nurse or holding on to a goal that has nothing to do with cancer, small steps taken now can make the weeks ahead feel more manageable. As Maureen Green put it when reflecting on her own treatment, the key is to accept help, ask for it when you need it and take things one step at a time. Start with the questions on the checklist below, bring them to your care team, and remember that every infusion you get through is one more behind you.

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