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A guide for patients about

diet during chemotherapy

Why do I need advice on what I should eat? A common side effect of chemotherapy can be to reduce the body’s ability to fight infections. It is important to take extra care with the food you eat to minimise the risk of picking up a food related infection. Many of the foods we eat contain small amounts of bacteria, viruses and fungi. For most people this is not a problem, but if your immune system is weakened these can prove harmful and may lead to infections. There is no reason, however, why you cannot continue to eat a wide variety of foods whilst you are receiving treatment. Symptoms that you may suffer from chemotherapy vary between treatments and individuals and your dietetic team can give specific advice. There are booklets available to help you cope with treatment side-effects, weight gain and weight loss. For further advice please ask your nurse to refer you to the oncology dietitian. Many herbal and vitamin supplements are not advised during chemotherapy. If you are already taking or considering taking a herbal or vitamin supplement please discuss this with the chemotherapy nurse. These guidelines aim to help you to lower the risk of a food borne infection by offering a list of higher risk foods which are best avoided. Other foods, not mentioned in this leaflet, are generally safe as long as attention to good food hygiene is observed. How long will I need to keep to these guidelines? It is recommended that you follow this advice for one month after completing your treatment. What are the foods I should avoid or be careful with?

Food Foods which are best to avoid Safer alternatives Milk and cream All unpasteurised or raw milk and

cream, including milk from sheep and goats.

Pasteurised, UHT(long life), sterilised and dried milk and cream, soya milk and cream.

Cheese All mould ripened and blue-veined cheeses such as brie, camembert and stilton, dolcelatte, danish blue and roquefort.

All unpasteurised cheeses for example parmesan, some goat and sheep cheeses.

By law it should state on the label whether a cheese is unpasteurised.

Take care with cheese bought from farmer’s markets and locally produced cheeses.

Pasteurised cheeses such as most cheddars, edam, gouda, jarlsberg, emmental, cottage cheese, mozzarella, feta, paneer, ricotta, halloumi processed cheeses such as philadelphia, dairylea and laughing cow.

Yoghurts, drinking yoghurt and pro-biotic drinks

All probiotic or ‘bio’ yoghurts and yoghurt drinks.

Yakult, Actimel and similar pre-biotic and pro-biotic products.

All other yoghurts and yoghurt drinks, fruit and natural varieties such as thick and creamy and greek yoghurts.

Ice cream Soft ice cream from ice cream vans or ice cream machines.

Home-made ice cream containing raw egg.

Tubs of ice cream, individually wrapped ice cream or ice lollies.

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Food Foods which are best to avoid Safer alternatives Eggs Undercooked or raw eggs.

Products that contain undercooked or raw eggs such as home-made mayonnaise, Caesar salad dressing, hollandaise sauce and mousses.

Well cooked eggs. Only use ‘lion branded’ eggs or those bought from a farmer who has a certificate to say that the flock of hens are salmonella free.

Shop bought mayonnaise is usually safe as it is made from dried egg powder or pasteurised egg.

Meat and meat products

Raw or under cooked meat, smoked meat, such as salami, pate, sliced, cold meats from an open counter.

Well cooked meat and poultry. Meat is well cooked when the juices are clear and no pink bits remain.

Tinned or jars of pate and paste, vacuum packed sliced cold meats

Fish and fish products

Raw or undercooked fish or shellfish for example fresh tuna, sushi, oysters, caviar.

Shellfish are safer if cooked and served hot.

Fresh, frozen, tinned and vacuum packed fish.

Smoked fish, if eaten from freshly opened package

Alcohol

Avoid on days when taking anti-sickness drugs and steroids.

Please check with your nurse for more specific advice.

Low alcohol or alcohol free beer and wine. Please remember to moderate your alcohol intake and include one or two alcohol free days each week.

What is good food hygiene? Remember to be particularly careful about food hygiene. If your immune system is weak, you may be more at risk of getting food poisoning. You may also be less able to cope with the symptoms of food poisoning. Below are some suggestions regarding good food hygiene: Food preparation • Use foods that are as fresh as possible and within their ‘use by’ date. • Always wash your hands well before preparing any food and wash them between handling any raw

and cooked foods. • Keep kitchen work surfaces clean. • Change your tea towels and dish cloths regularly. • It is safer to let crockery/cutlery dry naturally or use a dishwasher. • Wipe the tops of all cans and bottles before opening. • Wash all fruit and vegetables. • Discourage pets from areas where you prepare food, where possible. Cooking food • Ensure food is cooked thoroughly. • Make sure frozen food is completely thawed before cooking. • Cooked food should be cooled as quickly as possible before storing in the fridge or freezer. • When reheating food ensure that it is piping hot and do not reheat food more than once. • If using a microwave oven follow the manufacturer’s instructions and those on the food packaging.

Make sure that the advice on standing times is followed.

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Can I eat out? • It is best to order freshly cooked hot food and try to avoid buffet style counters or food that has been

kept warm for long periods. • Avoid self-service salad bars open to the environment. • Choose freshly prepared foods from reputable outlets and ensure the establishment has a good

standard of hygiene. Search for food hygiene ratings on www.food.gov.uk • Take extra care when abroad as food hygiene may be poorer. Contact the Acute Dietetic Team

01227 864236

Kent and Canterbury Hospital Ethelbert Road Canterbury Kent CT1 3NG

01843 234310

Queen Elizabeth the Queen Mother Hospital (QEQM) St Peters Road Margate Kent CT9 4AN

01233 616624

William Harvey Hospital Kennington Road Willesborough Ashford Kent TN24 0LZ

/Clinical-Nutrition-and-Dietetics

@KCHTDietetics

This information has been produced by the oncology dietitians, Kent Community Health NHS Foundation Trust, the clinical oncologists and the chemotherapy sisters, East Kent Hospitals University NHS Foundation Trust in accordance with the 2012/2013 consensus

update from the Haematology Subgroup of The BDA Oncology Group, January 2013.

If you would like this information in another language, audio, Braille, Easy Read or large print, please ask a member of staff.

You will be asked for your agreement to treatment and, if necessary, your permission to share your personal information.

Leaflet code: 00231 Published: March 2014 Expires: March 2017 Page 3 of 3

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Customer Care Team If you have a query about our health services, or would like to comment, compliment or complain about Kent Community Health NHS Foundation Trust, you can contact the Customer Care Team.

Phone: 0300 123 1807, 8am to 5pm, Monday to Friday Please say if you would like the team to call you back Text: 07943 091958 Email: kcht.cct@nhs.net

Address: Customer Care Team, Kent Community Health NHS Foundation Trust, Trinity House, 110-120 Upper Pemberton, Eureka Park, Ashford, Kent TN25 4AZ Web: www.kentcht.nhs.uk