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Cancer, Chemotherapy and Immunotherapy treatments, Diet and Nutrition

Food Safety Advice for Immuno‑Compromised Cancer Patients

During and after your cancer treatment your immune system becomes weakened (you become immuno-compromised). This is because the number of your white blood cells, which would normally help to fight these organisms, are falling (neutropenia). Therefore, good food safety is important.

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Why do I need advice on what to eat?

At this time you are at a greater risk of developing infections from bacteria or fungi which can be found in small amounts in many foods.

Some foods we eat contain small amounts of bacteria or other harmful microbes which for most people this is not a problem. However when your white blood cells are lower than normal you may be more likely to become unwell if you come into contact with bacteria.

This booklet outlines some simple steps to help reduce this risk both at home and when eating out.

How long do I need to keep to these guidelines?

Every patient is unique and the length of time you are encouraged to follow these guidelines can vary. In general we advise that you follow these guidelines during treatment and for three months after your last course of treatment, or until your immuno-suppression medication is stopped if you are taking these.

Important:

Note:

Immuno-suppression medication could be started at any given point therefore 
these guidelines may need to be restarted as these act on your immune system. 

Please discuss with your medical team or dietitian.

Food Safety – General advice

The following food safety and hygiene advice can help you reduce the chances of getting a food borne infection.

Shopping

• Avoid buying food with damaged or broken packaging.

• Check all use by dates and best before dates on packaging.

• Transport chilled and frozen foods home as quickly as possible. Use an insulated container or cool bag to help keep food at the correct temperature.

• Pack raw meats, poultry and fish in a separate carrier bag to other foodstuffs: remember the packaging may be contaminated.

• Avoid buying foods like meat, cheese and bread from open deli counters or sweets and chocolates from pick and mix stalls.

Food preparation

• Always wash your hands with warm soapy water before handling and preparing any foods.

• Wash your hands after going to the toilet, sneezing and after touching any pets, hair, dirty washing, rubbish or raw foods.

• Use a separate towel or use kitchen paper to dry hands. Do not use a tea towel.

• Cover any cuts and grazes with a waterproof plaster.

• Avoid preparing food if you have been unwell with food- related sickness and/or diarrhoea until at least 48 hours after symptoms have passed.

• Wash salad vegetables and fruit (if eaten with the skin on) thoroughly.

• Do not wash poultry under the tap as this can spread bacteria over the sink and work surfaces. Leave unwashed.

Storage

• Check fridge temperature. Fridges should be 0-5°C.

• Store cooked foods at the top of the fridge.

• Store raw or defrosting food at the bottom of the fridge in a covered container to stop it dripping or leaking out into the fridge.

• Use and store food following the manufacturer’s instructions. Use within best before or use by dates.

• Keep eggs in the fridge.

• Check your freezer temperature. Freezers should be below -18°C.

• Do not refreeze thawed foods.

• If food is frozen at home, label and date when put in the freezer and use within freezer star guideline on packet or inside door of the freezer.

Kitchen hygiene

• Keep the kitchen clean.

• Use a food safe sanitiser or disinfectant on food contact surfaces and hand contact surfaces (e.g. Microwave handles, fridge door handles, taps).

• Make sure any cloths or sponges are regularly bleached, disinfected or changed.

• Keep pets away from work surfaces, food and your dishes.

• Avoid cross – contamination of food by changing or washing chopping boards and utensils between raw and cooked foods. Ideally you should have three boards; one for raw meat, one for cooked meat and one for other foods.

Cooking

• Thaw meat and poultry in the fridge and not at room temperature.

• Always cook raw foods thoroughly and ensure the food is piping hot all the way through with juices running clear and with no pink showing.

• Cooking to above 63oC will kill most bacteria, but it is recommended that all cooked food reaches at least 70oC in the centre for a minimum of two minutes.

• Always follow the manufacturer’s cooking guidelines and do not shorten cooking times.

• Pre-heat the oven to make sure food is cooked at the recommended temperature.

• Always wash your hands before eating.

Reheating foods

• Avoid reheating rice and takeaway food.

• For home cooked foods, cover and cool food at room temperature within an hour after cooking and then place in the fridge or freezer.

• Eat reheated home cooked food within 24 hours of preparing or defrosting it. Reheat only once and ensure it is piping hot. Eat immediately.

Eating out

Use reliable / reputable outlets.

• Ask for food to be cooked fresh rather than anything that has been standing around.

• Avoid salad bars / deli, street vendors, market stalls and ice cream vans.

• Look for the food standards agency five star rating guides, with five being the top score for hygiene and cleanliness.

You can check businesses food hygiene rating on the following website: 

Food Hygiene Rating link
This picture shows the Food Standards Agency Rating certificate of Very Good to look for at a shop or when eating out.

This is why it is recommended that friends and relatives do not bring in takeaways / foods for you while you are in hospital. Any prepared food not eaten at the time it is prepared has time for bacteria to grow. This means food that is safe at home is not safe for you in hospital.

Foods which are safe to bring into hospital:

  • Breakfast cereal, porridge / oat pots.
  • Crisp breads / bread sticks.
  • Crackers.
  • Crisps / baked savoury snacks.
  • Cakes, bakery products (not fresh cream).
  • Biscuits.
  • Sweets and chocolates.
  • Instant noodles, rice or couscous pots.
  • Packaged dried fruit, nuts, cereal bars / flapjack.
  • Croissants with jam / chocolate spread / peanut butter.

Foods have been divided into two categories

Lower risk foods: foods which are considered safer to eat as long as they have been stored, handled and served appropriately as per manufacturers guidelines.

Higher risk foods: foods which there is a clear risk of infection and therefore encouraged to be avoided.

  • Raw or undercooked meat and poultry.
  • (Barbecued meat represents a particularly high risk and is best avoided altogether).
  • Cooked meat from the deli counter.
  • Salami or pepperoni if uncooked.
  • Cooked meat from the deli counter.
  • Salami or pepperoni if uncooked.

  • Well cooked meat and poultry. Juices must run clear and no pink showing.
  • Ensure all meat products like sausages, burgers are well cooked thoroughly.
  • Ensure pork and pork containing products are well cooked.
  • Vacuum packed sliced meat.
  • Salami or pepperoni if cooked.

  • Raw or lightly cooked shellfish e.g. prawns, mussels.
  • Sushi e.g. containing raw fish.
  • Smoked fish e.g salmon.
  • Vacuum packed fish.
  • All types of paté e.g. meat / fish / vegetable if bought refrigerated / unpasteurised.

  • Freshly cooked fish, fishcakes, fish fingers.
  • Well-cooked shellfish e.g. prawn curry.
  • Cooked dishes containing smoked fish.
  • Pate e.g. pasteurized in jar or tinned paste.

  • Unpasteurised milk.
  • Mould-ripened cheeses e.g. Brie, Camembert.
  • Unpasteurised cheeses e.g. Feta, Parmesan, goat’s cheese.
  • Blue-veined cheese e.g. Danish Blue, Blue Stilton (avoid all these cheeses unless cooked and steaming hot).
  • Yoghurt which is described on the label as bio or probiotic*.
  • Probiotic or “bio” foods, drinks or supplements e.g. Yakult, Actimel, Proviva.
  • Ice cream made with unpasteurised ‘raw’ milk

  • Any pasteurised milk/cream, UHT milk, sterilised milk. UHT squirty cream.
  • All hard pasteurised cheeses such as cheddar, Stilton & Parmesan
  • Soft pasteurised cheeses such as cottage cheese, mozzarella, feta, cream cheese, paneer, labneh, ricotta, halloumi, goats’ cheese without a white coating on the outside (rind) and processed cheese spreads
  • Any yoghurt including live, plain, Greek or fruit that does not describe itself as bio or probiotic.
  • Pasteurised ice cream. Wrapped individual ice creams or ice lollies. Check the food hygiene rating of the shop or van before having soft ice cream.
Important:

Note

The live bacteria used in making yoghurts are not harmful. So, yoghurt described as “live” is safe during neutropenia.

However, the bacteria used in bio or probiotic foods cannot be guaranteed as safe during neutropenia.

  • Undercooked (runny) or raw eggs.
  • Products containing raw egg e.g. soufflé, homemade mayonnaise, mousse, meringue.
  • Any dressing containing raw eggs e.g. home or restaurant e.g. Caesar salad dressing.
  • Hollandaise / Béarnaise sauce.

  • Well cooked eggs e.g. Use only Lion branded eggs or those bought from a farmer who has a certificate to show the hens are salmonella free.
  • Shop bought mayonnaise.

  • Unwashed fruit / vegetables or salad.
  • Damaged / over-ripe or bruised fruit.
  • Avoid deli counter foods e.g. salads, olives, houmous.
  • Raw sprouted seeds i.e. alfalfa, bean.
  • Freshly squeezed / unpasteurised fruit juice or smoothies.

  • Washed fresh fruit, salads and vegetables – including prepacked salad and fruit.
  • (Ensure all above are well washed under running tap water before eating, as bacteria can be present on the surface).
  • Tinned or frozen.
  • Prepacked olives /houmous.
  • Thoroughly cooked sprouted seeds.
  • Pasteurised fruit juice or smoothies.

  • Un-boiled water that is not from local authority supply.

  • If you drink water from a borehole or private water supply this must be boiled prior to drinking.
  • *Freshly run tap water if from local authority supply is considered on the whole safe to drink.
  • Ensure you run your water for a couple of minutes first and that it is a tap that is regularly used.
Important:

Note

* It is recognised that on rare occasions, some infections may be transmitted by tap water or private water supplies in Yorkshire and the rest of the UK.

Listen to any advice from health/local authority about the need to boil your water supply.

  • Unpasteurised fruit juices / milkshakes / smoothies.
  • Black pepper / herbs and spices e.g. loose bought products from deli / farm shops.
  • Avoid loose bought ‘refill stations’ for cereals, nuts & dried fruits.

  • Coffee, tea.
  • Pasteurised carton/bottles of drinks e.g. Oasis, Drench, Fruit shoots, Ribena.
  • Fizzy drinks.
  • Water with a hint of flavours – lemon, peach.
  • Black pepper / herbs and spices e.g. pre packed fresh sealed jars from supermarket.
  • Supermarket bought sealed packages for cereal, nuts, dried fruits, biscuits.

More information on safer shopping and eating can be found at: Food safety | Food Standards Agency

For any further information please contact your medical team, clinical nurse specialist or dietitian.

Acknowledgment – BDA Oncology Group Haematology Sub group Guidance: Safer eating with Neutropenia 2023.

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  • LN: LN003097
  • Edition number: 4th Edition • Version 1
  • Developed by: Haematology Dietitians at Leeds Teaching Hospitals NHS Trust
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