(Refer to the PDQ summary on Gastrointestinal Complications for more information on diarrhea.)
People with cancer may have a low white blood cell count for a variety of reasons, some of which include radiation therapy, chemotherapy, or the cancer itself. Patients who have a low white blood cell count are at an increased risk for developing an infection. Suggestions for helping people prevent infections related to neutropenia include the following:
- Check expiration dates on food and do not buy or use if the food is out of date.
- Do not buy or use food in cans that are swollen, dented, or damaged.
- Thaw foods in the refrigerator or microwave—never thaw foods at room temperature.
- Cook foods immediately after thawing.
- Refrigerate all leftovers within 2 hours of cooking and eat them within 24 hours.
- Keep hot foods hot and cold foods cold.
- Avoid old, moldy, or damaged fruits and vegetables.
- Avoid tofu in open bins or containers.
- Cook all meat, poultry, and fish thoroughly; avoid raw eggs or raw fish.
- Buy individually packaged foods, which are better than larger portions that result in leftovers.
- Use caution when eating out—avoid salad bars and buffets.
- Limit exposure to large groups of people and people who have infections.
- Wash hands frequently to prevent the spread of bacteria.
This list may be modified after chemotherapy or when blood count returns to normal.
Hydration and dehydration
Adequate hydration is critically important for health maintenance. There are several common scenarios found in cancer treatment that may lead to altered hydration status and electrolyte imbalance. Hydration status can become compromised with prolonged disease or treatment-related diarrhea and/or episodes of nausea and vomiting. Acute and chronic pain can also adversely affect the appetite and hence the desire to eat and drink. Fatigue, an all-too-common complaint of people with cancer, can be one of the first signs of dehydration. Once the underlying cause for altered hydration is appropriately managed, some suggestions to promote adequate hydration include the following:[32,52,53]
- Drink 8 to 12 cups of liquids a day; take a water bottle whenever leaving home. It is important to drink even if not thirsty, as the thirst sensation is not a good indicator of fluid needs.
- Add food to the diet that contains a significant portion of fluid, such as soup, flavored ice pops, flavored ices, and gelatins.
- Limit consumption of caffeine-containing products, including colas and other caffeinated sodas, coffee, and tea (both hot and cold); these foods may not be as nourishing as noncaffeinated beverages.
- Drink most liquids after and/or between meals to increase overall consumption of both liquids and solids.
- Use antiemetics for relief from nausea and vomiting; antiemetic use can be very helpful and may prevent hospital admissions from dehydration. The classes of available antiemetics include anticholinergics, phenothiazines, antihistamines, butyrophenones, benzamides, and serotonin receptor antagonists. Of note, all of these antiemetics have side effects that many individuals would consider less problematic than nausea and vomiting.