FOOD SAFETY DURING CANCER TREATMENT
There may be times during cancer treatment when the body is not able to protect itself very well. Cancer and its treatment can weaken the body’s immune system by affecting the blood cells that protect against germs. When your immune system is weakened, the first step in staying free from infection is being aware of and avoiding the bacteria and other organisms that can make you ill. Following safe food practices can reduce the risk of foodborne illness. Follow the practices outlined in this section to maintain good food safety.
Some foods should be avoided by anyone going through cancer treatment. These foods can contain high levels of bacteria:
Undercooked meat or poultry, especially ground meats
Raw or runny eggs, including nonpasteurized or homemade eggnog, smoothies or drinks made with raw eggs, unbaked meringues, or Caesar salad dressing made with raw egg
Nonpasteurized vegetable and fruit juice, unless prepared at home with washed produce
Uncooked vegetable sprouts (all kinds, including alfalfa, radish, broccoli, mung bean,etc.), because of a high risk of contamination with salmonella and E. coli
CLEANING PROPERLY
Wash your hands with warm, soapy water for twenty seconds before and after preparing food and after using the bathroom or touching pets. Always wash hands before eating.
Clean counters and cutting boards with hot, soapy water or a fresh solution made of one part bleach to ten parts water. Moist disinfecting wipes may be used if they’re made for use around food.
Use paper towels to clean kitchen surfaces. Cloth kitchen towels should be replaced daily and laundered in hot water.
Some types of cancer treatment can cause a condition known as neutropenia, or low white blood cell counts. Having neutropenia puts one at greater risk for infection and foodborne illnesses. If this happens, ask your health care team if you should follow specific diet guidelines. When white blood cell counts are low, your health care team may tell you to avoid additional foods.
Wash fruits and vegetables well under running water before peeling or cutting. Do not use soaps, detergents, or chlorine bleach solutions. With a clean vegetable scrubber, scrub produce that has a thick and rough skin or rind (such as melons, potatoes, bananas, etc.) or any produce that has dirt on it.
Packaged salads, slaw mixes, and other prepared produce, even when marked prewashed, should be rinsed again under running water. Using a colander or salad spinner can make this easier.
Wash the tops of canned goods with soap and water before opening.
HEATING AND STORING FOOD
Keep hot foods hot (warmer than 140°F) and cold foods cold (cooler than 40°F).
Keep your refrigerator set at or below 40°F. Use an appliance thermometer to be sure.
Do not refreeze foods once you’ve thawed them.
Refrigerate meat, poultry, seafood, eggs, and other perishable foods within two hours of buying or preparing them. Egg dishes and cream- and mayonnaise-based foods should not be left unrefrigerated.
If preparing hot food that won’t be served right away (or that you’ll be freezing or transporting later), divide into shallow dishes or containers so that it cools more quickly in the refrigerator.
Throw away fruits and vegetables that are slimy or moldy.
Throw away eggs with cracked shells.
Throw out foods that look or smell strange. Never taste them!
Discard food that has not been eaten in an appropriate timeframe. See the guidance on the next page for how long to keep specific foods on hand.
AVOIDING CROSS-CONTAMINATION
Keep raw meat, poultry, or seafood separated from other foods, both when grocery shopping and in the refrigerator.
If thawing raw meat or poultry in the refrigerator, place in a container to catch liquid. If possible, place the thawing food on a lower shelf in the refrigerator.
Keep foods separated on the countertops. Use separate cutting boards and clean knives for raw meats and other foods.
When grilling, always use a clean plate for the cooked meat.
Marinades used on raw food should not be used as a sauce. Reserve a portion before putting raw meat or poultry in it.
COOKING FOOD WELL
Ensure all meats, poultry, and fish are cooked thoroughly. Use a food thermometer placed into the thickest part of the food to be sure that meat and poultry reach the proper temperature. (See the chart of safe food temperatures on page 16.) Test a thermometer’s accuracy by putting it into boiling water—it should read 212°F.
When cooking in the microwave, rotate the dish a quarter turn once or twice during cooking if there’s no turntable in the oven. This helps prevent cold spots in food where bacteria can survive.
Cover leftovers when reheating. All leftovers should be brought to a minimum temperature of 165 degrees.
Cook eggs until both whites and yolks are firm, not runny.
When reheating soups, sauces, or gravies, be sure to bring to a boil.
When storing food in your refrigerator, follow these food storage safety guidelines.
CHOOSING FOOD CAREFULLY
Check “sell-by” and “use-by” dates. Pick only the freshest products.
Check the packaging date on fresh meats, poultry, and seafood. Do not buy products that are out of date.
Do not use damaged, swollen, rusted, or deeply dented cans. Be sure that packaged and boxed foods are properly sealed.
Choose unblemished fruits and vegetables.
Do not buy produce that has been cut at the grocery store (such as melon or sliced onions).
Do not eat deli foods prepared at the grocery store. In the bakery, avoid unrefrigerated cream- and custard-filled desserts and pastries.
Do not eat foods from self-serve or bulk containers unless they will be cooked.
Do not eat yogurt and ice cream products from soft-serve machines.
Do not eat food samples.
Only purchase refrigerated eggs, and check to be sure there are no cracked eggs.
Choose salsas or salad dressings that are shelf-stable, not items in the refrigerated section of the store.
Put meats, poultry, and seafood in plastic bags and put them in a separate area of the cart. At the check-out, ask that they be bagged separately from other food items.
Get your frozen and refrigerated foods just before you check out, especially during summer months.
Never leave food in a hot car. Refrigerate groceries right away. If you live far from the grocery store or it is very hot, take a cooler or thermal bags for frozen and refrigerated items.
EATING OUT SAFELY
Try to dine early to avoid crowds.
In fast-food restaurants, ask that food be prepared fresh. Ask for a modification from how it’s normally prepared (without onions, for example) to ensure your food is made to order.
Ask for single-serving condiment packages, and avoid self-serve bulk condiment containers.
Avoid salad bars, delicatessens, buffets and smorgasbords, potlucks, sidewalk vendors, and food trucks.
Avoid “fresh-squeezed” juices or sliced lemons or limes in restaurants or other food service establishments.
Be sure that utensils are put on a napkin or clean tablecloth or placemat, rather than right on the table.
If you want to keep your leftovers, ask for a container and put the food in it yourself rather than having the server take your food to the kitchen to do this.
Refrigerate leftovers as soon as possible, definitely within two hours. If the temperature outside is above 90 degrees, refrigerate them within an hour.
TAKING FOOD TO FRIENDS
One easy way to help someone going through treatment is to prepare food for his or her family. There are several online meal-organizing platforms now available that allow people to coordinate to provide meals for others. There are a few things that can be useful to remember in this situation:
Don’t send food in a container you need back. Avoid a situation in which the family has to be responsible for washing a dish, remembering whom it belonged to, and arranging to return it. Send food in disposable containers or include a note saying the dish doesn’t need to be returned.
Pay careful attention to these food safety guidelines, particularly with regards to transporting food and maintaining safe food temperatures.
Consider asking whether the person would like anything specific or has any current favorites. Don’t try to impress—comfort food is usually most desired.
Touch base if possible to be sure there aren’t food allergies or special dietary needs. Especially during treatment, a person’s tastes may change, or there may be certain foods that are particularly easy or difficult to tolerate. If you bring something homemade, consider providing a list of ingredients.
On sign-ins, give an idea of what you are bringing (or send an e-mail to check) so that the same foods aren’t repeated.
Remember that even if the person with cancer can’t eat everything you bring, the family will enjoy it. Your effort will be appreciated, and you are helping to ease a burden.
MINIMUM INTERNAL COOKING TEMPERATURES
You can’t tell if certain foods are safe to eat just by looking. Use a food thermometer to be sure. Use the following guidelines for safe internal cooking temperatures.
