The effect of the neutropenic diet in the outpatient setting: A pilot study

Purpose/Objectives: To determine whether use of the neutropenic diet in the outpatient setting decreases the number of febrile admissions and positive blood cultures associated with chemotherapy-induced neutropenia. Design: Descriptive pilot study, Setting: Outpatient chemotherapy unit of a medical center in a major metropolitan area. Sample: Convenience sample of 28 patients aged 33-67 years beginning treatment with 1 of 13 chemotherapy regimens. Methods: Twelve-week prospective study beginning on day 1 of chemotherapy cycle 1. Patients received instructions regarding the neutropenic diet before starting chemotherapy. Adherence assessment telephone calls were made at weeks 6 and 12. Hospital admission charts were reviewed at study completion. Main Research Variables: Adherence with neutropenic diet, number of febrile admissions, and number of positive blood cultures. Findings: Sixteen patients were compliant with the neutropenic diet, four of which were admitted for neutropenia with gram-negative rods. No significant differences were found in the rates of febrile admissions or positive blood cultures between compliant and noncompliant patients. Conclusions: Clinical significance in this pilot study is related to the time required for diet education, content of diet education regarding food restrictions, and difficulty adhering to diet requirements given the multitude of side effects (e.g., nausea, vomiting, mouth sores, diarrhea) of chemotherapy. Implications for Nursing: No clear evidence exists that the neutropenic diet makes a difference in overall rates of infection. Nursing research to compare the neutropenic diet with a less restrictive food safety education-focused diet is needed to guide clinical practice.