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 Pasteurised, UHT(long life), sterilised cream, including milk from sheep and and dried milk and cream, soya milk goats. and cream. All mould ripened and blue-veined Pasteurised such as most cheeses such as brie, camembert and cheddars, edam, gouda, jarlsberg, stilton, dolcelatte, danish blue and emmental, cottage cheese, , . feta, paneer, , halloumi processed cheeses such as All unpasteurised cheeses for example philadelphia, dairylea and laughing cow. 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. Yoghurts, drinking All probiotic or ‘bio’ yoghurts and All other yoghurts and yoghurt drinks, yoghurt and pro- yoghurt drinks. fruit and natural varieties such as thick and creamy and greek yoghurts. biotic drinks Yakult, Actimel and similar pre-biotic

and pro-biotic products. Ice cream Soft ice cream from ice cream vans or Tubs of ice cream, individually wrapped ice cream machines. ice cream or ice lollies.

Home-made ice cream containing raw egg.

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Food Foods which are best to avoid Safer alternatives Eggs Undercooked or raw eggs. Well cooked eggs. Only use ‘lion branded’ eggs or those bought from a Products that contain undercooked or farmer who has a certificate to say that raw eggs such as home-made the flock of hens are salmonella free. mayonnaise, Caesar salad dressing, hollandaise sauce and mousses. Shop bought mayonnaise is usually safe as it is made from dried egg powder or pasteurised egg. Meat and meat Raw or under cooked meat, smoked Well cooked meat and poultry. Meat is products meat, such as salami, pate, sliced, cold well cooked when the juices are clear meats from an open counter. and no pink bits remain.

Tinned or jars of pate and paste, vacuum packed sliced cold meats Fish and fish Raw or undercooked fish or shellfish for Shellfish are safer if cooked and served products example fresh tuna, sushi, oysters, hot. caviar. Fresh, frozen, tinned and vacuum packed fish.

Smoked fish, if eaten from freshly opened package Alcohol Avoid on days when taking anti-sickness Low alcohol or alcohol free beer and drugs and steroids. wine. Please remember to moderate your Please check with your nurse for more alcohol intake and include one or two specific advice. 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 01843 234310 01233 616624

Kent and Canterbury Hospital Queen Elizabeth the Queen William Harvey Hospital Ethelbert Road Mother Hospital (QEQM) Kennington Road Canterbury St Peters Road Willesborough Kent CT1 3NG Margate Ashford Kent CT9 4AN 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.

Customer Care Team If you have a query about our health services, or would like to If you would like this information in another comment, compliment or complain about Kent Community Health language, audio, Braille, Easy Read or large .16 16.05 NHS Foundation Trust, you can contact the Customer Care Team. print, please ask a member of staff.

Phone: 0300 123 1807, 8am to 5pm, Monday to Friday You will be asked for your agreement to treatment Please say if you would like the team to call you back and, if necessary, your permission to share your Text: 07943 091958 Email: [email protected] personal information.

Address: Customer Care Team, Kent Community Health NHS Leaflet code: 00231 Published: March 2014 Foundation Trust, Trinity House, 110-120 Upper Pemberton, Expires: March 2017 Eureka Park, Ashford, Kent TN25 4AZ Web: www.kentcht.nhs.uk Page 3 of 3

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