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6 Steps for Safe Food Handling

Cancer patients are susceptible to neutropenia, a common side effect of chemotherapy that can put a patient at increased risk for infection.  Neutropenia is when neutrophils, a major type of white blood cell responsible for fighting off infection, are abnormally low.  When these levels are abnormally low, patients can be more susceptible to infectious pathogens, including food-borne bacteria.  Therefore, it is important for cancer patients to handle food safely during treatment.

Research indicates that the role of diet in the development of infection in patients with neutropenia is unclear, which contributes to the variation in dietary restrictions among institutions that range from more general food safety guidelines to the more strict Neutropenic Diet.


Food Safety Guidelines

The United States Department of Agriculture (USDA) has developed food safety guidelines for people with cancer, which are also recommended by the Centers for Disease Control (CDC).  Key components of these guidelines include the following: [i]

  1. Washing hands in warm soapy water before handling, preparing, and eating food
  2. Consuming only pasteurized juices and dairy products
  3. Consuming food that has not passed the expiration date
  4. Washing raw produce well prior to consumption
  5. Storing raw meat, fish, and chicken carefully in wrapped containers to avoid spillage of juice that con potentially contaminate other food
  6. Avoiding raw or undercooked meat, poultry, fish or shellfish


The Neutropenic Diet

Some institutions follow a more restrictive protocol called the Neutropenic Diet.  This more restrictive diet excludes most fresh fruits and vegetables as well as eating outside of the home. To date, no evidence-based studies support added benefit from the use of the Neutropenic Diet when compared to general food safety guidelines.  Although there are no official published guidelines of its use,  its use is not unsafe and remains part of many high quality medical institutions’ dietary protocols at this time [ii][iii].

It is important to remember that cancer and cancer treatment can result in a weakened immune system and that every precaution should be taken to minimize exposure to potentially harmful germs and pathogens.  Practicing safe food handling throughout treatment is the first step in helping to reduce risk of infection.


[i] USDA: “Food Safety for People with Cancer” www.fisi.usda.gov/PDF/Food_Safety_for_People_with_Cancer.pdf
[ii] Steven J. Jubelirer: The Benefit of the Neutropenic Diet: Fact or Fiction? The Oncologist 2011;16: 704 –707
[iii] Moody et al: Feasibility and Safety of a Pilot Randomized Trial of Infection Rate: Neutropenic Diet Versus Standard Food Safety Guidelines. Journal of Pediatric Hematology 2006; 28:126-133
Jessica Iannotta, MS, RD, CSO, CDN

Jessica is a registered dietitian and certified specialist in oncology nutrition (CSO). She studied nutrition at Cornell University and completed her dietetic internship at New York Presbyterian Weill Cornell Medical Center. She obtained her Master's degree through the University of Medicine and Dentistry of New Jersey. Jessica has worked in inpatient and outpatient oncology settings since 2001 in the North Shore-LIJ Health System. Jessica is in charge of all operations including clinical and culinary operations ranging from menu development to evidence-based website content, relationships with registered dietitians and social workers and developing processes and protocols for intake, management and outcomes analysis of patients.

  1. Thanks for posting this . I’ve been looking for this info . Great information I will be back for more info in regards to juicing recipes for weight loss.

  2. I’ve heard of a lot of different tnteemarts ranging from eucalyptus to new types of drugs. If you’re interested, you should look into clinical trials. These go on quite a bit and only need a little bit of research to find. The National Cancer Institute should have some pretty good information on how to go about finding them.

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