Background: Side effects of curative chemotherapy regimens are highly prevalent and can lead to unplanned oncology clinic visits or hospital-level care. The current study aim was to examine physical symptoms among patients at their first chemotherapy visit, even prior to receiving their first infusion, in order to characterize symptom burden and unmet needs at this early stage of care. Methods: The current study utilized baseline data from a larger health services research trial for consecutive patients initiating chemotherapy for non-metastatic breast (48.0%), colorectal (28.0%), or lung (24.0%) cancer (n=75). Patients were invited to complete a self-report survey at their first chemotherapy visit, including demographics and measures of physical symptoms (Memorial Symptom Assessment Scale) and psychological distress (Patient Health Questionnaire-4; score ≥ 3 indicates positive anxiety or depression screen). Results: Among participants (M age=55.3 [SD=13.3]; female=70.7%), more than half (54.7%) endorsed at least one physical symptom -- primarily fatigue (34.7%) and constipation (29.3%). Additionally, one-fourth (25.3%) screened positive for anxiety (22.7%) and/or depression (9.3%). There were no differences in physical symptom bother or likelihood of fatigue or constipation, by factors including patient age, gender, marital status, work status, disease type, recent surgery, or concurrent radiotherapy. However, patients with positive anxiety and/or depression screens reported greater symptom bother and were more likely to endorse fatigue relative to those with negative screens (Mbother=4.5 vs. 1.3; fatigue=78.9% vs. 19.6%, p’s<.01). There was no difference in constipation between these groups. Conclusions: Symptom frequency was markedly high among patients initiating curative chemotherapy, with at least half reporting physical symptoms prior to their first infusion, and psychological distress clustered with general symptom bother and fatigue. Future work should explore 1) the extent to which physical and psychological symptoms at chemotherapy initiation may be associated with longitudinal symptom profiles, and 2) strategies for addressing symptom burden early on in outpatient care.