Food Safety During Chemotherapy: A Plain-Language Guide

Food safety takes on extra importance during chemotherapy. The National Cancer Institute explains that some treatments make it easier to get sick from contaminated food, because they can lower the white blood cells your body uses to fight infection. The reassuring part is that the steps that help are straightforward and familiar: clean, separate, cook, and chill. A few foods warrant extra care during treatment, and there are certain warning signs worth acting on quickly. Because how careful to be depends on your treatment and your counts, your care team's guidance always comes first.

Not everyone's risk is the same. How much extra care makes sense depends on your specific treatment, where you are in your treatment cycle, and your blood counts at a given time. There are stretches when infection-fighting white blood cells are especially low, and during those windows the body has a harder time handling germs, including ones from food. So some people need to be more careful than others, and that can change over the course of treatment.

Household routines matter too. Someone who cooks most meals at home has more control over food safety than someone who eats out often or relies on prepared foods. Neither is wrong — it just shapes which steps help you most.

• Clean. Wash your hands well before and after handling food. Rinse fruits and vegetables under running water, and keep counters, cutting boards, and utensils clean.
• Separate. Keep raw meat, poultry, seafood, and eggs away from foods that won't be cooked. Use separate cutting boards and utensils to avoid spreading germs.
• Cook. Cook meat, poultry, fish, and eggs thoroughly, since heat kills harmful bacteria. Reheat leftovers until steaming hot.
• Chill. Refrigerate perishable food promptly, keep cold foods cold and hot foods hot, and don't let food sit out at room temperature for long.

• Raw or undercooked meat, poultry, fish, shellfish, and eggs — including raw sushi and runny eggs.
• Unpasteurized milk, soft cheeses, and juices, which can carry harmful germs.
• Deli meats and hot dogs unless heated until steaming.
• Raw sprouts, which are harder to clean thoroughly.
• Damaged or expired produce and packaged foods; check freshness and storage.

Ask your care team which of these matter most for your treatment, since the emphasis can vary.

Ask your care team whether your treatment raises your risk of foodborne illness, and whether that risk is higher at certain points in your cycle. NCI points to a dedicated resource called "Food Safety for People with Cancer" that goes into more detail — ask your team if they can share it or something similar. Most importantly, know the warning signs. During treatment, a fever of 100.4–100.5°F (38°C) or higher can be a sign of a serious infection that has to be handled as an emergency, and vomiting or diarrhea after eating is worth reporting rather than waiting out. Sources word this threshold slightly differently, so use the number your own team gave you.

• Call 911 or go to an emergency department if you are confused, faint, breathing fast, or your skin is cold and mottled. Those point to sepsis, and hours matter.
• Treat a fever as an emergency. If your temperature hits 100.4°F (38°C) or higher, CDC says a fever during chemotherapy is a medical emergency. Phone your team at once, day or night, and head for an emergency department if nobody answers straight away.
• Call your care team the same day if you have vomiting or diarrhea you cannot settle, blood in your stool, or you are passing hardly any urine after a suspect meal.
• Call your care team within a day or two if mild stomach upset drags on for more than a couple of days, or eating and drinking are getting harder.

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

• National Cancer Institute — Infection and Neutropenia During Cancer Treatment
• CDC — Fever During Chemotherapy Is a Medical Emergency