As a chemo nurse, I hear it all the time. My patient will see me come up to their infusion chair with my gown on, double gloving, grabbing a face shield, and ask- is this my chemotherapy? Or is this the other one?

I get it. It can be confusing! Patients often get them both while going through active treatment. Then, many switch to maintenance therapies which are infusions that still might come out in a yellow chemo bag, even though they’re not.

At my center, these infusion drugs often come out in a similar looking, yellow, “chemotherapy” bag. These types of drugs are hazardous- even though they are going directly into someone’s bloodstream. That’s the only place we as nurses want them going. And what I tell my patients is that as a nurse who’s dealing with those drugs every day, we get exposed to minuscule amounts, day-in, day-out, which can be hazardous over time. So even though a drug may be a targeted therapy, it still comes out in a “chemotherapy” bag. Sometimes a medication will be found to no longer belong on the “hazardous” list. So

The most basic explanation that I often give patients is this:

Chemotherapy goes into a body, rambo-style, guns blazing, taking out rapidly dividing cells, both good and bad. A couple examples of chemotherapy are paclitaxel, or adriamycin.

Targeted Therapy is more like a sniper. It is more precise, and just like the name implies, these drugs “target” something in the body, such as a protein on the outside of a cell. These drugs are small molecules or can be monoclonal antibodies such as pembrolizumab (generic for the brand name, Keytruda). A type of testing called biomarker testing may be done to see if a patient would benefit from this type of therapy.

Immunotherapy encompasses a wide variety of medications, including G-CSFs (granulocyte colony-stimulating factors, or injections such as Granix and Neulasta) and also infusions like nivolumab. These medications help someone’s immune system fight back in some manner. G-CSFs are drugs that essentially work to elevate the white blood cell count, helping people stay out of the hospital after chemotherapy when without the injection, their counts would plummet and they wouldn’t be able to fight off infections. These types of drugs (G-CSFs) have their own profile of side effects, such as bone pain. This bone pain may be felt in the bigger bones of the body, since the bones are being stimulated to make more white blood cells. This injection wouldn’t come in a yellow “chemo” bag, it just gets pulled from the pyxis (or given out by the pharmacy), and it’s a quick shot given the day after chemotherapy treatment. Some patients even give themselves these injections at home.

Chemotherapy often comes with side effects like nausea, hair-loss, neuropathy, fatigue, cold sensitivities, and also side effects that can be life-threatening like low white blood cells (neutropenia), and low platelets (thrombocytopenia). A person may experience taste changes or mouth sores that make it very difficult to eat. Some of those side effects like hair loss, are annoying and can affect one’s self-image. Low platelets or white blood cells can be very serious, and your nurse may call to review “fever precautions” or “bleeding precautions,” telling you what to look for.

Targeted therapy can cause side effects too, but many of the medications that I see in the outpatient setting are typically tolerated very well. That doesn’t mean that these drugs can’t cause more serious side effects- they can- it’s just that I don’t see those as often as side effects from chemotherapy, or when they do occur, they are less severe.

Unless they’re not. There are always exceptions. Some patients cruise through their chemotherapy regimen without barely batting an eyelash. They wouldn’t even know they were sick. Their only side effects may be low blood counts, which are addressed. Other people struggle with the entire process, from the instant their port is inserted until the entire ordeal is over, and their port can finally be removed. Some people are on treatments for the rest of their lives. They get infusions every couple of weeks, which keep their cancers from growing and spreading. Some people wind up in the hospital again after one round of chemo.

Everyone is different!

Do you know someone going through treatment right now? I’d love to hear from you.