Nutrition for patients with HCL Ciara Tansey Dietitian

Nutrition for patients with HCL Ciara Tansey Dietitian The Royal Marsden NHS Foundation Trust #Future. Of. Cancer

Contents • World Cancer Research Fund Recommendations • Symptoms and Side effects • Strategies • Food safety

World Cancer Research Fund Recommendations

Be a healthy weight

Be physically active

World Cancer Research Fund Recommendations

Limit consumption of red and processed meat • Red meat – beef, lamb and mutton, pork, veal, venison, goat • Remain good sources of protein and iron • Max 70 g/day • Processed meat – sausages, bacon, ham, salami, corned beef, luncheon meats including those made from chicken and turkey

Limit consumption of red and processed meat • portion of Sunday roast (3 thin-cut slices of roast lamb, beef or pork, each about the size of half a slice of sliced bread) – 90 g • grilled 8 oz beef steak – 163 g • cooked breakfast (2 standard British sausages, around 9 cm long, and 2 thin-cut rashers of bacon) – 130 g • large doner kebab – 130 g • 5 oz rump steak – 102 g • quarter-pound beef burger – 78 g • thin slice of corned beef – 38 g • a slice of black pudding – 30 g • a slice of ham – 23 g

World Cancer Research Fund Recommendations

Limit alcohol consumption

World Cancer Research Fund Recommendations

Symptoms and Side effects • • • Tiredness & fatigue Lack of appetite & early satiety Nausea Changes in bowel habit Anxiety Neutropenia

Strategies • Tiredness & Fatigue - Make the most of help from others with shopping and cooking - Rationalise naps - Consider timings of meals - Prepare ahead of time - Use of convenience foods

Strategies • - Lack of appetite & early satiety Little and often Avoid skipping meals Don’t wait to feel hungry Food fortification Choose what you fancy

Strategies • Nausea - Discuss medications with your doctor/nurse Consider timings of medications Fresh air before meals Limit cooking smells ? Ginger

Strategies • Changes in bowel habit - Food and symptom diary Fibre manipulation Medications Ensure adequate fluid intake

Strategies • Anxiety - Don’t put pressure on yourself Eat what you can and try again later Eat with family and friends Discuss your concerns with the team

Diet and Neutropenia • Dietary recommendations for neutrophils <2. 0 • Aiming to reduce the risk of infection • Focus on food safety and hygiene

Neutrophil counts < 2. 0 x 109/litre

Further food safety advice for a neutrophil count below 0. 5 x 109/litre

General Food Safety Advice - Priority • Shopping – avoid bruised/damaged food stuffs • Clean – hands, surfaces, fruit and vegetables • Separate – chopping boards and utensils for raw products • Cook – ensure piping hot • Chill – refrigerate perishables within 2 hours, thaw foods in fridge • Storage – don’t overfill fridge, check labels • Eating out/takeaways - ensure reputable source, check hygiene ratings e. g. Scores on the Doors https: //www. scoresonthedoors. org. uk/

Summary • Aim to maintain a healthy weight and lifestyle using WCRF recommendations as a guideline • If you are struggling with side effects of treatment, the above recommendations may not be practical for you • If you are having any difficulties with your eating and drinking, there are many helpful strategies you can implement • Ask for a referral to the Dietitian if you have specific concerns or questions

Useful Resources • • World Cancer Research Fund Macmillan Healthy Eating Resources Cancer Research UK The Royal Marsden “Eating well when you have Cancer” booklet • Bloodwise • Scores on the Doors