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NoIL: 691 Version: 2 First Published: 01/2019 Review Date: 09/2022 Last Reviewed : 09/2020 Author: Nutrition and Dietetic Service

Gateshead Health NHS Foundation Trust Nutrition and Dietetic Service Queen Elizabeth Hospital Sheriff Hill, Gateshead, NE9 6SX Tel: 0191 445 2074 Your Dietitian is: …………………………………………………………………………………………..

Data Protection Any personal information is kept confidential. There may be occasions where your information needs to be shared with other care professionals to ensure you receive the best care possible. In order to assist us to improve the services available, your information may be used for clinical audit, re-search, teaching and anonymised for National NHS Reviews. Further infor-mation is available in the leaflet Disclosure of Confidential Information IL137, via Gateshead Health NHS Foundation Trust website or the PALS Service.

This leaflet can be made available in other languages and formats upon request

Nutrition and Dietetic Service Eating during chemotherapy

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References Macmillan (2013) ‘Avoiding infection when you have a reduced im-munity’ information page, accessed 5th February 2014 at http://www.macmillan.org.uk/Cancerinformation/Livingwithandaftercancer/Symptomssideeffects/Othersymptomssideeffects/AvoidingInfection.aspx Leukemia and lymphoma research (2012), ‘dietary advice for patients with neutropenia’ The Royal Marsden Hospital ‘Eating when you have cancer’, PDF docu-ment available at URL https://www.royalmarsden.nhs.uk/your-care/living-and-beyond-cancer/eating-well , accessed February 2019 Royal Marsden Hospital cancer information pages accessed at URL https://www.royalmarsden.nhs.uk/your-care/living-and-beyond-cancer/eating-well accessed February 2019

The World Cancer Research Fund ‘ Cancer prevention recommenda-tions’ available at URL https://www.wcrf.org/dietandcancer/cancer-prevention-recommendations, accessed February 2019 NHS, ‘The eat well guide’ (2016), at URL https://www.nhs.uk/live-well/eat-well/the-eatwell-guide/ accessed February 2019

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The Eatwell Guide includes: Eating plenty of fruit and vegetables Eating plenty of bread, rice, potatoes, pasta and other starchy

foods – choose wholegrain varieties whenever you can and include these foods at each mealtime.

Include milk and dairy foods Include some meat, fish, eggs, beans and other non-dairy sources

of protein (lean / reduced fat varieties) Limit foods which are high in fat and sugar Choose unsaturated oils and use in small amounts Check the labels on packaged foods and choose foods low in fat

salt and sugar Include six to eight glasses of water per day

Following advice from the Eatwell Guide and guidelines from the World Cancer Research Fund will help you to achieve a healthy lifestyle. Your health professional can refer you to a Registered Dietitian should you wish to lose weight or require more individualised advice for example on a special diet or if you have diabetes.

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Introduction Cancer and its treatment can have a number of effects on the body. Chemotherapy can affect your appetite and enjoyment of food and may lead to weight changes. It can also have an affect on your immune system, reducing the body’s natural defences against infection. This booklet will outline food safety and dietary advice to follow

during your chemotherapy treatment.

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Food safety advice One of the most effective ways of avoiding infection is to maintain high levels of hygiene. The following points may help:

Purchasing food:

Do: Don’t: ×

Always check use by and best before dates on packaging.

Don't buy foods where the packaging may be damaged and avoid buying from overloaded fridge or freezers as the food may not be cold enough.

Purchase chilled/frozen foods last and take the food home as quickly as possible, using a cool bag to carry food. Avoid salad bars

Don't choose foods from large self service containers where food is unwrapped such as sweets.

Pack raw and cooked foods in separate food bags. Buy pre packed deli items instead.

Don't buy meat where raw and cooked meats are stored in the same fridge or loose from a deli counter.

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If you have had no change to your appetite or weight The World Cancer Research Fund has published guidelines for the general population on ways to reduce cancer risk and to eat well. These guidelines can be used by people who have and those who haven’t got cancer. These guidelines include: Reduce or maintain your weight to within a healthy range

Limit intake of energy dense foods and sugary drinks

Limit fast foods

Eat mostly foods of plant origin – for example fruit and vegetables,

whole grains and pulses. Aim to eat at least five portions of fruit

and vegetables per day

Avoid processed meat and limit your intake of red meat to three

portions per week which is equivalent to 350- 500g (12-18oz).

Replace with poultry, meat alternatives or fish.

Limit your alcohol

Limit salt and salty/processed foods

Aim to meet nutritional needs through diet alone, avoid the use of dietary supplements (tablets).

Be physically active

The Eatwell guide (2016) as a visual guide to show the proportions of

foods that we should eat to have a healthy and well balanced diet.

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Storage

Do: Don’t: ×

Refrigerate foods between 0oand 5oC and freeze below -18oc.

Don't overload your fridge or freezer as this can stop if from working properly.

Store cooked food at the top of the fridge with raw or defrosting meats stored at the bottom of the fridge and in a sealed container.

Don't place hot food in the fridge or freezer.

Avoid overloading the fridge or freezer.

Cool food before refrigerating, cool at room temperature and within an hour of cooking. Place into smaller containers to allow quicker cooling rather than cooling in a large container.

Refrigerate eggs and store in their box.

Defrost meat and poultry in a fridge rather than at room temperature.

Ensure food is solid frozen when first taken out of the freezer and do not refreeze food.

Use food within manufacturers use by or best before dates.

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Preparing food

Do: Don’t: ×

Wash hands thoroughly using hot soapy water before and after preparing foods as well as after visiting the toilet, sneezing or touching pets etc.

Don't use a tea towel to dry pots.

Use a separate towel or tissue to dry hands rather than using a tea towel.

Don't allow pets near work surfaces, food storage or cooking utensils.

Drip dry pots or dry using kitchen towel rather than using a tea towel.

Don't use the same chopping board for raw or cooked meat.

Wash can tops before opening.

Don't drink directly from a container, bottle or can.

Regularly change cloths and sponges.

Use separate utensils and chopping boards for raw and cooked foods to prevent cross contamination.

Regularly clean/disinfect work surfaces.

Keep pets away from work surfaces, food storage and food.

Wear a waterproof plaster if you have any cuts or grazes.

Wash fruit and vegetables well before using.

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Fortifying your food If you have a small appetite and cannot manage large portions it is important to make the food you are eating more calorific and energy dense without increasing the size of the portion. Try some of the following: Add extra butter/margarine, peanut butter or chocolate spread to

foods Add cream to soups and milky desserts Use evaporated milk, condensed milk or cream (pouring or whipped)

to top desserts, cakes and hot drinks. Try grating cheese into foods Add extra jam, honey or syrup to sweet foods Use plenty of sugar/honey on cereals and in hot drinks and puddings Add sweet sauce to ice creams Add four heaped tablespoons powdered milk to one pint full cream

milk and use on breakfast cereals, in sauces, with puddings, soups, jellies and other desserts

Add one scoop of ice cream to cold drinks Whilst your appetite is poor buy full fat foods i.e. thick and creamy

yoghurts Try to fry foods where possible if able to tolerate Add mayonnaise or oil-based dressings to salads, sandwiches and

jacket potato fillings, or use as a dip for crisps or chips

If you have diabetes or any other condition requiring a special diet, or if you have ongoing concerns regarding your appetite and weight, you may find it useful to speak with your health professional who can refer you to a registered dietitian for more individualised advice. You will be given information by the chemotherapy day unit on coping with common chemotherapy side effects such as taste changes, nausea, diarrhoea and constipation. Again referral to a dietitian can allow individualised advice should this be needed.

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If you have a poor appetite or have lost weight It is important to try and eat well during chemotherapy to provide the essential nutrients and energy that your body needs as well as to rebuild damaged tissue and fight infection. However there may be times during your cancer treatment when you may find eating well more difficult. This may be due to the illness or due to treatment side effects. Losing weight or eating less than usual can make it more difficult for you to cope with your chemotherapy treatment or to fight infections. At this time it is important to relax any healthy eating restrictions and focus on eating well and enjoying your food as much as possible. Eating on a little and often basis may help. This may involve eating small meals or snacks every few hours. Nutritious fluids such as full fat milk should also be included regularly throughout the day. Ideas for light meals and snacks: Cake, malt loaf, jam tart Biscuit – cream, chocolate or plain varieties Chocolate bar Scoop of ice cream Thick and creamy yoghurt, full fat mousse or dessert such as

custard or rice pudding Crisps Fruit scone with butter and jam or cheese scone with butter Sausage roll, pies, pastries, pizza – party type food Cheese (hard, pasteurised type) and crackers ‘Cream of’ type soups with bread and butter Beans, scrambled egg or cheese on toast Baked potato with fillings such as cheese, beans or tuna Omelette Small sandwich containing egg (well cooked), meat, fish or cheese Slice of toast and butter Bowl of cereal with full fat milk

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Do: Don’t: ×

Cook food thoroughly until the centre is hot.

Do not reheat cooked foods as this may allow bacteria to grow.

Ensure juices run clear from cooked meat.

Don't shorten cooking times, always follow manufacturer’s guidelines.

Use microwaves for defrosting as long as food is cooked right away.

Use microwaves to heat prepared foods according to manufacturer’s Instructions.

Pre-heat the oven to ensure food is cooked at the correct temperature and that the food is hot throughout.

Cooking food

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Do: Don’t: ×

Choose a reputable establishment with good food hygiene practices – check their food safety rating on their door or via the foods standards agency.

Don't share foods from table tops (eg buffets, nuts and crisps in bars)

Make sure food is hot and thoroughly cooked before eating.

Avoid foods from salad bars, hot dog vans, market stalls and other street vendors, ice cream served in large containers from ice cream vans.

Buy individually wrapped ice creams/ice lollies from ice cream vans or shops.

Avoid eating at hot buffets and avoid food which has been sitting under a lamp.

Eating out

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Eating during chemotherapy Foods to Avoid During chemotherapy to minimise infection risk you should avoid the following foods: Raw/lightly cooked eggs including home made mayonnaise,

mousse, egg nog, meringue and sauces made with raw egg Soft unripened cheese such as brie, camembert or goats cheese, as

well as blue veined cheese such as Danish blue and stilton. Soft cheese made with unpasteurised milk e.g. feta or parmesan.

Pate Grapefruit and Seville oranges including juice and products

containing these. Probiotics or ‘bio’ foods drinks or supplements ie Yakult, Actimel or

ProViva. Yoghurt which is described on the label as ‘bio’ or ‘probiotic’. Yoghurts described as ‘live’ can be eaten safely as an alternative. Raw or undercooked meat or raw fish Your doctor or nursing staff will monitor your blood levels during treatment, and should your white blood cells (neutrophils) fall below a particular level (neutropenia) you will be given more detailed advice on any further dietary restrictions needed.