How Do I Keep Food Safe During Cancer Treatment?

NCI puts the reason in one sentence on its infection page: some cancer treatments make it easier for you to get sick from contaminated food.

The mechanism is the same one behind every other precaution during treatment. Chemotherapy lowers your white blood cells, and there are stretches in each cycle when your neutrophils are especially low. A germ that would once have caused a bad evening can cause a hospital admission.

FDA is blunter about the stakes. If you have a weakened immune system, you are at increased risk for a severe case of food poisoning.

None of this makes the kitchen dangerous. It makes the ordinary rules worth actually following.

NCI's food safety instructions during treatment are short enough to memorize:

• Make sure the meat, fish, and eggs you eat are well cooked.
• Keep hot foods hot and cold foods cold.
• You may be advised to eat only fruits and vegetables that can be peeled, or to wash all raw fruits and vegetables very well.

Alongside these, NCI's wider infection advice asks you to wash your hands often and well, especially before eating, and to have people around you wash theirs too.

That is the whole of NCI's food safety list. Notice what is not on it: no ban on fresh food, no list of forbidden ingredients.

FDA's booklet for people with cancer builds the same advice into four headings.

Clean. Wash hands in warm soapy water for at least 20 seconds before and after handling food. Wash cutting boards, dishes, utensils, and countertops with hot soapy water between preparing raw meat and preparing anything that will not be cooked. Rinse produce under running water and scrub firm-skinned fruit and vegetables with a clean brush, including ones with skins you do not eat.

Separate. Keep raw meat, poultry, seafood, and eggs away from other foods in the cart, the bags, and the refrigerator. Put raw meat on the lowest shelf so its juices cannot drip. Never put cooked food back on a plate or board that held raw meat without washing it first.

Cook. Use a food thermometer rather than judging by color. Reheat leftovers to 165°F. Bring sauces, soups, and gravy to a boil when reheating.

Chill. Keep the refrigerator at 40°F or below and the freezer at 0°F or below. Refrigerate perishables within 2 hours of cooking or buying them, or within 1 hour if it is above 90°F outside. Never thaw food on the countertop.

FDA's safe minimum internal temperatures answer the question "is this cooked?" without guesswork:

• Ground beef, pork, veal, and lamb: 160°F.
• Ground turkey and chicken: 165°F.
• All poultry, whole or in pieces: 165°F.
• Steaks, roasts, and chops of beef, veal, lamb, and fresh pork: 145°F, then rest 3 minutes.
• Fish: 145°F, or until the flesh is opaque and separates easily with a fork.
• Egg dishes: 160°F. Plain eggs: until the yolk and white are firm.
• Leftovers and casseroles: 165°F.

Shellfish get a look rather than a number. Shrimp, lobster, and crab until the flesh is pearly and opaque. Clams, oysters, and mussels until the shells open. Scallops until the flesh is milky white or opaque and firm.

A cheap food thermometer is the single most useful thing on this page.

FDA's restaurant advice is to ask, and to be willing to change your order.

Tell the server you do not want any item containing raw meat, poultry, seafood, sprouts, or eggs. Ask how a dish was cooked. If the server does not know, ask to speak to the chef. If you are still unsure, choose something else.

Do not order meat rare. Refrigerate any leftovers within 2 hours, or within 1 hour if it is above 90°F.

FDA lists the signs of foodborne illness as nausea, diarrhea, vomiting, fever, and abdominal cramps. Its first instruction is to contact your healthcare provider immediately.

During chemotherapy, fever moves to the front of that list. CDC says call at once at 100.4°F (38°C) or higher, and treats a fever during chemotherapy as a medical emergency.

FDA also suggests keeping the suspect food. Wrap it, label it "DANGER", freeze it, and keep the packaging and the receipt. Write down what you ate and when symptoms started.

• Does my treatment put me at higher risk of foodborne illness, and when is that risk highest?
• Are there foods you want me to avoid completely?
• Who cooks for me matters — is there anything my household should change?
• What symptoms after a meal should make me call you?

This is general information. Your care team's specific instructions for your treatment always take priority.

• NCI — Infection and Neutropenia during Cancer Treatment
• FDA — Food Safety for Older Adults and People with Cancer, Diabetes, HIV/AIDS, Organ Transplants, and Autoimmune Diseases
• CDC — Fever and Cancer Treatment