DeMille, D., Deming, P., Lupinacci, P., & Jacobs, L. (2006). The effect of the neutropenic diet in the outpatient setting: A pilot study. Oncology Nursing Forum, 33, 337–343.

The study examined adherence to neutropenic diet and whether differences existed in rates of hospital admissions for febrile episodes and positive blood cultures between patients who adhered to the neutropenic diet and those who did not.

Data collected at 6 and 12 weeks.

• The study started with 28 participants; 23 completed the study.
• Participants' age range was 33–67 years.
• Patients had a wide range of diagnoses (except acute leukemia and HIV). Patients with acute leukemia and HIV were excluded.
• Adult patients were eligible to be included if they were to receive chemotherapy associated with a high degree of neutropenia and were not being treated with colony-stimulating factors (CSFs).

Outpatient cancer center

• Rates of hospital admissions for febrile episode
• Rates of positive blood culture

Questionnaires were developed to document demographic and medical variables as well as baseline knowledge of food safety and the neutropenic diet. Adherence to restrictions of the neutropenic diet was measured via self-report based on “yes” or “no” questions and a food-use questionnaire. The 6- and 12-week evaluations measured dietary adherence as a self-reported subjective statement with “yes” or “no” responses.

Adherence was verified via eight questions targeting specific points of the food safety aspects and diet restrictions covered in the instruction. Patients’ degree of difficulty in following the diet was assessed using Likert scales with four response choices. Patients were questioned regarding hospital admissions; however, the researchers verified all admission information via chart review. The instrument designed to collect information was developed specifically for this study to assess the major aspects of the neutropenic diet for food safety and the diet instructions as given to patients. Content validity was established by review of the tool by a multidisciplinary team.

A chart review was conducted post-treatment to validate self-reported medical information and verify neutropenia (i.e., absolute neutrophil count [ANC] less than 1,000/mm³). The chart review was reviewed by a multidisciplinary team for content validity.

Fisher’s exact test was used to analyze proportions between the groups.

30% of patients were noncompliant with the neutropenic diet.

No differences were found in the rate of febrile hospital admissions (per patient report and confirmed by chart review) and positive blood cultures between those patients who adhered to the neutropenic diet and those who did not.

• Reports of whether patients adhered to a neutropenic diet were done by patients via a survey at 6- and 12-week intervals, which may have decreased the accuracy of self-reported data.
• No randomization of patients was done. The convenience sample compared patients who were compliant with a neutropenic diet with patients who were noncompliant.
• It was a small outpatient study in one setting; therefore, results cannot be generalized.
• Content validity of the tool was established at the institution. Reliability was not tested.

Of note, this study underscores the time spent for diet education, the question of appropriate content of diet education regarding food restrictions, and the difficulty adhering to diet requirements.