Neutropenia and Anemia

Low blood counts, including leukopenia, neutropenia, and low hemoglobin levels, can occur during chemotherapy. Although no individual dietary change can directly improve leukopenia or neutropenia, patients should be strongly advised to follow food safety guidelines and practice good hygiene to prevent potential infection.

Patients experiencing anemia should include a high-quality protein at each meal, for example: Greek yogurt or eggs at breakfast; sliced turkey breast or tuna at lunch; and salmon, beans, or tofu at dinner; and snack on nuts, nut butters, and seeds between meals. Protein provides amino acids, which are the building blocks to generate new blood cells.

Patients should increase their consumption of iron rich foods such as liver, red meats, poultry, leafy green vegetables (eg, spinach, Swiss chard, collard, turnip, mustard greens, romaine lettuce), and beans/legumes (eg, soybeans, lentils, garbanzo, lima, navy, kidney, black, and pinto beans). Vitamin C-rich foods such as red peppers, strawberries, and citrus fruits, eaten together with iron-rich foods maximize iron absorption.

In the past, patients were instructed to avoid all raw food, including raw fruits and vegetables, during neutropenia. More recently, hospitals and organizations have liberalized their food safety restrictions as this restriction has not been shown to reduce infections.

Raw fruits and vegetables can be consumed if washed thoroughly, but patients should be instructed to avoid raw and undercooked meat, eggs, fish, unpasteurized cheese and milk products, and spoiled or expired foods. Best practices for food safety include avoiding cross contamination of raw meats and produce, washing hands thoroughly when coming into contact with food, and avoiding high-risk food sources such as salad bars and street vendors where there may be higher risk of exposure to bacteria that can cause food-borne illness.

Healthy Recipes for Cancer Patients

Because so many cancer patients ask the question of “what to eat,” we included 2 recipes to accompany the strategies outlined in this article. Both recipes can be prepared in 15 minutes or less and are designed to be easily tolerated during cancer treatment.

Cool Cucumber Avocado Soup 
This recipe is appropriate for patients experiencing lack of appetite, nausea, vomiting or heartburn, constipation, diarrhea, fatigue, mouth sores, dry mouth, chewing or swallowing difficulty, taste aversion to sweet or sour foods, lack of taste, or smell aversions. Prep time: 15 minutes, serves 4.

Ingredients

  • 2 avocados, peeled and pitted
  • 1/2 medium-size cucumber, peeled and cut into smaller pieces
  • 1 cup cold water
  • 1/2 cup milk
  • 2-4 tablespoons freshly squeezed lemon juice
  • 2 ice cubes
  • 1/2 teaspoon salt, plus more to taste (optional)
  • Toppings: ½ cup chopped tomatoes, 2 teaspoons olive oil, chopped fresh chives, 3 sprigs fresh dill

Directions

  1. Place the avocado, cucumber, water, milk, 2 tablespoons of the lemon juice, and the ice cubes and salt in a food processor or blender. Blend until completely smooth. Season to taste with more lemon juice or salt.
  2. Top with the chopped tomatoes, a splash of olive oil, chopped chives, and some dill.

Note: if the patient has mouth sores, nausea or heartburn, avoid the tomato topping.

Excerpted from Bratton S, Iannotta J. The Meals to Heal Cookbook. Copyright © 2016. Boston, MA: Da Capo Press / Lifelong Books; 2016.

Peaches and Cream Oat Smoothie
This recipe is appropriate for patients experiencing lack of appetite, nausea, vomiting or heartburn, constipation, diarrhea, and fatigue, as well as mouth sores, dry mouth, chewing or swallowing difficulty, taste aversion to sour foods, lack of taste, or smell aversions. Prep time: 5 minutes, serves 1.

Ingredients

  • 1/2 cup rolled oats
  • 1/3 cup plain yogurt
  • 3/4 cup milk
  • 1 small peach, pitted or ½ cup frozen peaches
  • 1/2 medium-size frozen or fresh banana, sliced
  • 1 tablespoon ground flaxseeds
  • pinch of salt

Directions

  1. Combine all the ingredients in a blender.
  2. Blend and pour into a large cup or bowl.

Note: if the patient is experiencing bloating, omit the flaxseeds. Sipping on a smoothie can help supplement added nutrition. The added ingredients in this smoothie also work as a small meal.

Excerpted from Bratton S, Iannotta J. The Meals to Heal Cookbook. Copyright © 2016. Boston, MA: Da Capo Press / Lifelong Books; 2016.

Frequently Encountered Scenarios

A significant amount of cancer research can be found in books, magazines, and on the internet; much of which is misinformation. Uninformed patients and caregivers can easily fall prey to unreliable and dangerous health-related guidance when seeking information on diet and nutrition for cancer patients. When patients express interest in questionable dietary information or practices, you should consult with oncology-credentialed dietitians. In addition, consult with patients’ physicians when pursuing new nutrition and/or supplement strategies. Ensuring you are prepared to address scenarios in which you are confronted by a patient or family member is also helpful.

A patient is on a self-imposed restricted diet during treatment. Patients with cancer commonly change their diets, often drastically, to avoid sugar, gluten, and dairy foods and make other changes they believe will have a positive effect on the outcome of their cancer journey. These self-imposed restrictions are usually not warranted. If a patient is at nutritional risk due to the impact of treatment side effects, including weight loss, or poor appetite, encourage the patient to liberalize their diet to make staying well-nourished easier. Encourage a well-balanced diet adequate in calories and protein during treatment to support the patient on their journey. A referral for a nutrition consultation with an oncology-credentialed dietitian could be warranted to further evaluate.

A patient’s family, friend, or caregiver is making dietary demands. People who are close to the patient hope to help by researching or seeking out information. This frequently leads to an abundance of, and sometimes differing, opinions about the patient’s diet. Although being respectful of family, friends, and caregivers is important, you also must honor the patient’s intentions, goals, and wishes. If necessary, you can help the patient and loved ones strategize on other ways the loved ones can be helpful, especially if dietary control is becoming a stressful or sore subject.

When a patient asks, “what should I eat at meal times?” Many patients with cancer want to be told exactly what to eat. Referring them to nutrition resources such as nutrition services at the cancer center, Savor Health, the American Institute for Cancer Research, the American Cancer Society, and others can provide reliable and trusted information and support. If patients are looking for general healthy meals, some suggestions include: unsweetened Greek yogurt, eggs, oatmeal, or smoothies for breakfast; lentil soup, salads with beans or grilled chicken, and nutrient-dense smoothies for lunch; and a well-balanced meal with plenty of vegetables, lean animal or plant protein, and a whole grain carbohydrate for dinner. Referral to an oncology-credentialed dietitian for individualized meal planning is always a worthwhile recommendation because a dietitian can create a tailored meal plan that is specific to each patient’s unique nutritional needs and preferences.

Conclusion

Oncology nurses play a vital role in the interdisciplinary team, as they are often the advocate for patients as well as a trusted source of information, advice, and empathy. Having the tools and knowledge — most importantly an understanding of the role of nutrition in cancer care — to support their patients in a multidisciplinary way is essential. This includes enhanced awareness of the risk factors for malnutrition, learning appropriate and up-to-date tools to screen patients for nutritional risk, and guiding patients through their nutritional concerns. Working closely with the oncology-credentialed dietitians within your area can ensure that every patient has early and ongoing access to nutritional counseling. In doing so, patients can achieve and maintain an optimal nutrition status to improve their treatment outcomes and maximize their quality of life.


Susan Bratton is founder and chief executive officer and Jessica Iannotta is chief operating officer of Savor Health, a nutrition platform that offers dietary counseling and meal services for persons with cancer, based in New York, New York. 


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