Food and Fluid Plan for Chemo Day

An infusion day has a shape, and it is longer than the infusion. Bloodwork, waiting, the drip itself, then the drive home and an evening you did not plan for. Food and fluid handled well will not make the day pleasant, but they stop it from getting worse.

This is a plan for one day. Adjust it once you have been through a cycle and know how your own body behaves.

Do the packing while you still feel fine. On treatment morning you will not want to.

NCI's advice on preparing for chemotherapy is worth following literally: arrange someone to drive you there and back, plan time to rest on the day of treatment and the day after, and line up help with meals and childcare for the same stretch. Cooking on infusion evening is a plan that fails.

Eat a normal dinner and go to bed reasonably early. If you cook ahead, freeze something in single portions for tomorrow night.

Unless your team told you to fast for a scan or a procedure, eat before you go.

The American Cancer Society is specific here: most people find a light meal or snack an hour or so before chemotherapy works best. An empty stomach makes nausea worse for many people, and a heavy one makes it worse for others. Light and early splits the difference.

Good options are the bland, starchy ones NCI names for nausea: toast, plain pasta, rice, crackers, pretzels. Add a little protein if it appeals: a boiled egg, yogurt, peanut butter on the toast.

Skip anything greasy, fried, very sweet, or heavily spiced. NCI lists all four as things to avoid when food makes you feel sick.

ACS notes that if you will be there several hours, you should plan ahead and bring a small meal or snack. The catch is that whatever you bring will sit in a bag in a warm room.

Federal food safety guidance is clear on the timing. Bacteria multiply fastest between 40°F and 140°F, called the danger zone, and perishable food should not sit out longer than 2 hours. Above 90°F, such as a car in summer, that drops to 1 hour. Treatment lowers the white blood cells that fight infection, so this is not a rule to bend.

Two ways to work with that:

Pack food that does not need refrigeration. Crackers and peanut butter, pretzels, dry cereal, plain cookies, shelf-stable nutrition drinks, sealed applesauce cups, roasted nuts if your mouth is fine, hard candy for taste changes.

Or pack a small cooler with an ice pack for yogurt, cheese, or a sandwich, and eat it in the first couple of hours.

Also worth bringing: a marked water bottle, mints or sugar-free gum for metallic taste, plastic forks if metal tastes wrong, and your anti-nausea medicines in case you need a dose before you get home.

Infusion units are dry, warm rooms and it is easy to drink almost nothing for six hours.

Set an hourly target instead of a daily one. Roughly a cup an hour while you are awake gets most people close. Sip rather than gulp: NCI suggests sipping only small amounts of liquid during meals so fluid does not crowd out food.

If you are losing weight, NCI suggests choosing fluids with calories instead of plain water. A milkshake or a supplement drink counts as both fluid and food.

Ask before you assume the unit provides drinks. Many do, and knowing spares you carrying six hours of liquid.

The window that catches people out is not the infusion. It is that evening and the next two days.

Take the anti-nausea medicines on the schedule you were given, not only when you feel sick. Nausea is far easier to prevent than to reverse once it starts.

NCI's practical advice for these hours:

• Eat five or six small meals instead of three larger ones.
• Choose cold foods such as popsicles, pudding, yogurt, and gelatin. Cold food smells less.
• Stay with bland, starchy things: toast, rice, plain pasta, crackers, pretzels.
• Foods containing ginger may help ease symptoms.
• After eating, rest sitting upright or lying with your head raised for 30 minutes.
• Sip water, broth, fruit juice, ginger ale, tea, or sports drinks through the day to prevent dehydration.

This is also where the frozen portion from last night earns its place.

If someone brings food, refrigerate it within 2 hours. Reheat leftovers to 165°F rather than just warming them through. Eating Hints says to eat refrigerated leftovers within 3 days and to skip leftover rice.

Buffets, salad bars, and bulk bins are on the Eating Hints avoid list, which rules out a lot of convenient food on a tired evening. Sealed, single-serving, and freshly cooked are the safer choices.

• Call your care team right away, at any hour, if your temperature reaches 100.4°F (38°C) or higher at any point after the infusion. With low white blood cells this is a medical emergency in CDC's words, and it needs an answer that hour, not in the morning. If you cannot reach them quickly, go to an emergency department and say you have just had chemotherapy. Go in as well if you are too dizzy to stand, have barely passed urine all day, or are confused and cannot be roused properly after hours of vomiting or diarrhea.
• Call your care team the same day if the anti-sickness medicines are not holding the vomiting, you have kept nothing down for 24 hours, or you are having seven or more bowel movements a day above your usual number, which NCI grades as severe and possibly life-threatening.
• Call your care team within a day or two if you lose more than 3 to 5 pounds in one week, which NCI says to report straight away, or if food and drink have tasted wrong for days and you are eating far less than you did before the cycle.

• Do I need to fast, or should I eat before I come in?
• How long will this infusion take, door to door?
• Which premedications will I get, and how do they affect appetite, blood sugar, or sleep?
• Does the unit provide drinks and snacks, or should I bring everything?
• Exactly when should I take the anti-nausea medicines at home, on which days?
• Which day of the cycle is usually worst, so I can plan food for it?
• What number should I call after hours, and with which symptoms?

Read next: Eating During Chemotherapy, Eating When You Have Nausea, Staying Hydrated During Cancer Treatment, Food Safety During Cancer Treatment, and What to Expect at an Infusion Center.

• https://www.cancer.gov/about-cancer/treatment/types/chemotherapy
• https://www.cancer.gov/about-cancer/treatment/side-effects/nausea
• https://www.cancer.gov/about-cancer/treatment/side-effects/appetite-loss
• https://www.cancer.gov/about-cancer/treatment/side-effects/diarrhea
• https://www.cancer.gov/publications/patient-education/eatinghints.pdf
• https://www.foodsafety.gov/keep-food-safe/4-steps-to-food-safety
• https://www.foodsafety.gov/food-safety-charts/safe-minimum-internal-temperatures
• https://www.cancer.org/content/dam/cancer-org/cancer-control/en/booklets-flyers/nutrition-for-the-patient-with-cancer-during-treatment.pdf
• https://www.cancer.gov/about-cancer/treatment/side-effects/infection
• https://www.cdc.gov/cancer-preventing-infections/patients/fever.html