Food safety for people having chemotherapy (Systemic Anti-Cancer Treatment)

Practical tips and advice at a time when you may be more prone to infections

Cancer treatment may make you more prone to develop infections, partly because the neutrophils (which normally fight infection) may be low and also because the gut lining that normally acts as a barrier between the bacteria and the bloodstream can be damaged. It’s therefore important to be careful with food to reduce the risk of food poisoning.

Following the guidelines below will help you to minimise any risk:

Shopping

Check ‘use by dates’ and ‘best before dates’. Always use food within the recommended period.
Avoid broken packaging.
Avoid bruised or damaged fruits and vegetables.
It is safer to buy pre-packaged cheese and cold meats rather than from the delicatessen due to risk of cross contamination. Avoid buying foods from salad bars or pick ‘n’ mix that are used by multiple people.
Take chilled and frozen foods home quickly and put away at once. If possible, use a cool box to transport cold foods.

Storage

Keep the coldest part of your fridge between 0-5°C and your freezer below -18°C. A fridge thermometer can be a useful way to check this.
Cool cooked food quickly and cover before storing in fridge or freezer.
Store raw and cooked food separately, with raw food at the bottom.
Do not refreeze food once it has started to thaw, raw food is ok to refreeze once it has been cooked.
Always cover food to be stored to prevent contamination.
Always store your eggs in the fridge

Food preparation

Always wash your hands thoroughly before and after preparing food.
Keep your kitchen clean; wash worktops using an antibacterial spray and make sure that all sponges, dishcloths and dishtowels are cleaned frequently.
To avoid cross-contamination, always use different chopping boards for raw and cooked food. Clean utensils between handling raw and cooked food.
Wash fruit and vegetables thoroughly under running water.
Keep pets away from food preparation areas as they may carry bacteria even if they are well.

Cooking

Ensure that food is cooked thoroughly and piping hot throughout, especially meat, poultry and fish products.
Meat should be cooked until the juices run clear.
Always follow the instructions on packaged food.
Serve hot foods as soon as possible after preparation

Reheating foods

Cool left-over food quickly (ideally within one hour of cooking), then cover and store in fridge or freezer.
Eat any left-over food within 24hours and make sure that they are heated until piping hot throughout when served.
Do not reheat food more than once.
Do not reheat cooked rice.

Take aways and eating out

When eating out, check the food hygiene rating and only eat from restaurants and take aways with a 5-star food hygiene rating. A 5-star rating means that the hygiene standards are very good and in line with the law. You can check the Food Standards Agency website for ratings: www.ratings.food.gov.uk
Only eat food that is cooked to order and eat it immediately. Be aware that the length of time between cooking and eating and transport conditions will be uncertain for take away delivery services.
Be aware of cross contamination from food left out for long periods of time and serving utensils which are shared by multiple people e.g. at buffets or salad bars.
Avoid reheating take away food.

Foods to avoid during cancer treatment

Some foods are more likely to cause food poisoning and should be avoided whilst you are having treatment and for 14 days after completing the last cycle of treatment.

All unpasteurised dairy products including mould ripened and blue veined cheeses, for example brie, camembert, goat’s cheese and stilton. Any cheese made with pasteurised milk is fine to eat.
Raw or undercooked eggs or any food made from uncooked eggs (e.g. dressings or sauces such as mayonnaise). Choose Lion marked eggs as these are marked with a code showing the type of farming system, country of origin and farm production unit. The British Lion scheme has been responsible for a drastic reduction in the presence of salmonella in UK eggs.
Rare or undercooked meat, fish and shellfish
Raw fish such as sushi or sashimi
Smoked salmon
Fresh pâté (meat, fish or vegetable)
Any deli counter foods (due to risk of cross contamination)
Foods labelled ‘probiotic’ or ‘bio’ e.g. Yakult/Actimel drinks or yoghurt with added
bacteria. If you wish to include these foods in your diet, please discuss with your consultant.

Eating well during chemotherapy

It is important to maintain a nutritious and well-balanced diet. This will help you to cope with any side-effects you may experience during treatment, prevent unintentional weight loss, reduce the risk of infections and help with recovery.

Eating well means having a varied and well-balanced diet that will provide your body all the nutrients it needs to function well. For more details ask for our booklet Healthy eating for people with cancer (CISS-26). If you are struggling to maintain a healthy weight or have a poor appetite, please ask for a copy of Eating well with a small appetite (CISS-25).

Common side effects of chemotherapy

Side effects are common during chemotherapy, e.g. fatigue, loss of appetite, taste changes, dry/sore mouth, nausea and vomiting and bowel changes (constipation or diarrhoea). They can all impact on your nutritional intake. For further information on how to manage these please ask for our leaflet Common nutritional problems and cancer (CISS-24).

Weight loss during chemotherapy

Small weight changes may occur as a result of chemotherapy and do not need to cause you concern. Significant weight loss may affect your ability to tolerate treatment and can also lead to muscle loss, in turn resulting in decreased strength, weakness and fatigue. If you have lost a lot of weight or are struggling with eating, please ask your nurse for further guidance which may prompt a referral to the Macmillan Specialist Dietitians.

Alternative diets

There is plenty of information in the media about ‘complementary’ or ‘alternative’ diets claim to cure or control cancer.

To date there is little scientific evidence to support claims made by alternative diets. These diets are potentially harmful because they are often low in energy (calories) and protein and/or tend to be bulky, making them very filling. Therefore, they can cause weight loss in people who are already experiencing problems eating due to their cancer treatment.

If you are thinking of following any of these diets, please discuss it with your health professional first.

Vitamin and mineral supplements

Most people, when they are well, are able to get all of the nutrients that they need from a balanced and varied diet. The exception to this is Vitamin D. The main source of Vitamin D is sunlight, and although it is found in some foods (e.g. oily fish, red meat, liver, egg yolks, fortified cereals and spreads), it is difficult to get enough Vitamin D from diet alone.

All adults should consider taking a daily supplement of 10 micrograms (mcg) of Vitamin D, especially during autumn and winter. Some at risk groups, people over 65, people with darker skin tones, people who cover their skin outside should consider taking a daily supplement of 10 mcg Vitamin D all year round.

If you wish to take a vitamin and mineral supplement to ensure you are getting all of the nutrients you need, choose a general multi-vitamin and mineral supplement providing approximately 100% of RNI (Reference Nutrient Intake). Suitable options include Tesco A- Z (or other supermarket own brand A-Z), Sanatogen A-Z, Superdrug or Boots A-Z. If you struggle to take whole tablets, a chewable option is Centrum Fruity Chewables, to be taken twice daily or as an alternative Superdrug Chewable A-Z.

Warning: high dose vitamin & mineral supplements are not recommended as they may interact with your cancer treatment. If you have any queries about other supplements or food additives, please discuss with your health care professional.

Free prescriptions

All cancer patients undergoing treatment for cancer, the effects of cancer or the effects of cancer treatment can apply for an exemption certificate for a free prescription from their GP.