Neutropenia and Diet
In June 2001, the Joan Karnell Cancer Center
at Pennsylvania Hospital received a grant from
the Oncology Nursing Society to conduct a pilot
study, “Effects of the Neutropenic Diet
in the Outpatient Setting.” The following
is a summary of the study and its results which
concluded in December 2003.
During chemotherapy treatment, patients may experience a side effect
known as neutropenia. Neutropenia is the severe drop in white blood
cells – cells that protect the body against infection.
This condition can result in hospitalization or a delay in chemotherapy
treatment, but patients can avoid neutropenia by reducing their exposure
to bacteria and other agents that can cause infection. Exposure can
also be reduced through diet. This neutropenic diet is based on avoiding
raw fruit and vegetables since food carries outside bacteria.
While there is research on the diet’s effectiveness for inpatients
receiving chemotherapy, outpatients were not studied.
Three questions were addressed for this study:
- Are outpatients receiving chemotherapy able
to comply with a neutropenic diet?
- Is there a difference in the number of febrile (fever) admissions
between compliant patients (patients who follow the diet) versus
non-compliant patients (patients who do not follow the diet)?
- Is there a difference in the number of positive blood cultures
(indicating bacterial infections) between compliant versus non-compliant
patients?
Patients between 18 and 70 years old, who were receiving outpatient
chemotherapy at the Joan Karnell Cancer Center at Pennsylvania Hospital
and Pennsylvania Oncology and Hematology Associates, were enrolled
for 12 weeks. Patients were instructed on how to follow a neutropenic
diet before starting their chemotherapy.
Follow-up calls were made to participants during weeks six and 12
of the study. The following are the study results:
Study
Results |
Are outpatients
receiving chemotherapy able to comply
with a neutropenic diet? |
Of the 23 patients
who completed the study, 16 patients
(70 percent) were compliant with the
diet. |
Is there a difference
in the number of febrile admissions
between compliant versus noncompliant
patients? |
Of the 23 patients
who completed the study, nine had hospital
admissions or visits to the emergency
room. However, only five of these admissions
were for neutropenia (22 percent). Of
the 16 compliant patients,who properly
followed the diet guidelines, four (25
percent) were admitted for neutropenia.
Of the seven non-compliant patients,
only one was admitted for neutropenia. |
Is there a difference
in the number of positive blood cultures
between compliant versus non-compliant
patients? |
Of the five patients
admitted for neutropenia, four had positive
blood cultures for gram negative rods
(associated with food-borne bacteria).
Of these four patients, only one patient
had not followed the neutropenic diet. |
In summary, about one-third of patients who participated in the study
did not properly follow the neutropenic diet. However, following or
not following the diet did not make a difference in fever-induced
hospital admissions. In addition, there was no difference in bacterial
blood infections in those who did or did not follow the diet.
The clinical significance in this pilot study is related to the time
required for the diet education, content of diet education regarding
food restrictions, and the difficulty patients have adhering to diet
requirements given the number of side effects of chemotherapy. Future
study is required in order to determine the best practice to improve
outcomes for the treatment of neutropenia.
Special thanks to all the patients who participated. In addition,
the Cancer Center would like to thank the Oncology
Nursing Society and Amgen® for supporting this study.
|
