The Case for Eliminating the Neutropenic Diet

Although there is no scientific evidence that a specific diet reduces risk of infection in patients experiencing neutropenia, it is a common strategy in cancer care. Research presented at the 42nd Annual Congress of the Oncology Nursing Society determined that the popular neutropenic diet can be eliminated from practice.

Researchers from the University of Pittsburgh Medical Center (UPMC) presented findings from a literature review and the results of their facility eliminating the neutropenic diet in patients with cancer.

“In a literature review that included two meta-analyses, we found that not one study has ever shown a reduction in infection or mortality rates,” Chelsea Nee, BSN, RN, OCN, of UPMC-Shadyside, said during a poster and discussion detailing the improvement project, as reported by CURE^®.

A neutropenic diet requires patients to avoid certain foods that might carry bacteria, such as fresh fruits and vegetables, unpasteurized juices, milk, honey, yogurt, and cheese; cheese that is soft or contains molds; cold-brewed tea; raw oats and nuts; deli meat; and sushi.

The neutropenic diet dates back to the 1970s when a study included the diet as one way to support the well-being of patients who underwent a stem cell transplant. However, with other interventions taking place, there was no solid evidence that the neutropenic diet contributed to the decrease in infections that the study had shown, according to Nee.

At UPMC-Shadyside, it took a year to get the quality improvement program to eliminate the neutropenic diet going—they had to educate nurses, physicians, and dieticians about the concept and remove the diet from electronic health records.

Instead of implementing a diet, patients with cancer were asked to engage in standard safe food handling practices. After discussions with hematologists, the decision was made to keep patients who were undergoing stem cell transplant on a strict diet similar to the neutropenic diet, but allow them to eat fresh fruits and vegetables.

The neutropenic diet was officially removed from UPMC-Shadyside on May 13, 2015. Data on the incidence of bacteremia, Costridium difficile infections, and pneumonia were collected before and after the program launched. The researchers found no increase in infections and actually found that adhering to the neutropenic diet was associated with an increase in the likelihood of developing pneumonia.

“Many oncology patients have a difficult time meeting nutritional requirements, so the liberalization of diet restrictions has improved the selection of what they can safely eat,” the authors wrote in their abstract.