Knowledge of and Compliance with Neutropenic Diet in Patients with Hematologic Malignancy undergoing Chemotherapy

Ok Kyung Jeon; Yeon Hee Lee; Myung Hee Kim

doi:10.5388/aon.2018.18.2.75

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Jeon, Lee, and Kim: Knowledge of and Compliance with Neutropenic Diet in Patients with Hematologic Malignancy undergoing Chemotherapy

Original Article

Asian Oncol Nurs 2018;18(2):75-85.

Published online: 5 June 2018

DOI: https://doi.org/10.5388/aon.2018.18.2.75

Knowledge of and Compliance with Neutropenic Diet in Patients with Hematologic Malignancy undergoing Chemotherapy

Ok Kyung Jeon¹, Yeon Hee Lee², Myung Hee Kim³

¹Department of Nursing, Pusan National University Hospital, Busan, Korea

²Department of Nursing, Dong-Eui University, Busan, Korea

³College of Nursing, Pusan National University, Yangsan, Korea

^∗ This manuscript is revision of the first author's master's thesis from Pusan National University.

Address reprint requests to: Lee, Yeon Hee Address: Department of Nursing, Dong-Eui University, 176 Eomgwangro, Busanjin-gu, Busan 47340, Korea Tel: +82-51-890-1563 Fax: +82-0505-182-6876 E-mail: vandi@deu.ac.kr

Received 8 May 201822 Jun 2018 Accepted 26 Jun 2018

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

초록

Purpose

This study aimed to investigate knowledge of and compliance with the neutropenic diet in hemato-oncology patients undergoing chemotherapy.

Methods

123 hemato-oncology patients who had more than one chemotherapy participated in this study. Data were collected with a self-administered questionnaire from July 21 to September 26, 2014, and analyzed with SPSS 21.0 program using descriptive statistics, t-test, ANOVA and Pearson's correlation.

Results

The average of score for the neutropenic diet was 60.9 out of 100 points and mean compliance score was 69.5 out of 100 percent scale. For preventing infection, patients were found to be stricter in their intake of restricted foods than acceptable foods during neutropenia. There were significant correlations between the knowledge of and compliance with the neutropenic diet in patients receiving chemotherapy (r=.53, p<.001).

Conclusion

It is necessary to nursing assessment and education should include a periodic assessment of nutritional status and risk evaluation of neutropenia and bacterial infections. This study recommended nursing research to establish a recommendation criterion for a restrictive neutropenic diet and less restrictive food safety education programs for cancer patients.

Keywords: Drug Therapy, Compliance, Diet, Knowledge, Neutropenia

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Table 1.

Characteristics of the Subjects (N =123)

Characteristics	Categories	n (%)	M ± SD
Gender	Male	70 (56.9)
	Female	53 (43.1)
Age (year)	20~39	21 (17.1)	56.2 ± 16.22
	40~59	45 (36.6)
	≥60	57 (46.3)
Educational level	≤ Middle school	40 (32.5)
	High school	53 (43.1)
	≥ College	30 (24.4)
Religion	Yes	84 (68.3)
	No	39 (31.7)
Inmate	Yes	87 (70.7)
	No	36 (29.3)
Employment status	Employed	58 (47.1)
	Unemployed	65 (52.9)
Monthly income (10,000 won)	＜ 100	44 (35.8)
	100~＜200	20 (16.2)
	200~＜300	31 (25.2)
	≥300	28 (22.8)
Diagnosis	Leukemia	44 (35.8)
	Lymphoma	44 (35.8)
	Multiple myeloma	25 (20.3)
	Myelodysplastic syndrome	10 (8.1)
No. of chemotherapy cycle	≤3rd	45 (36.6)	6.04 ± 5.28
	4~6th	43 (35.0)
	7~10th	19 (15.4)
	≥11th	16 (13.0)
Serum albumin (g/dl)	＜ 3.5	21 (17.1)	4.19 ± 0.59
	≥3.5	102 (82.9)
%IBW (%)	70~ 80	5 (4.1)	112.58 ± 63.65
	70~＜80	5 (4.1)	112.58 ± 63.65
	80~＜90	13 (10.6)
	≥90	105 (85.3)
Cooking	Self	28 (22.8)
	Spouse	56 (45.5)
	Children	10 (8.1)
	Siblings	6 (4.9)
	Parents	20 (16.3)
	Others	3 (2.4)
Number of meals	1	2 (1.6)
	2	8 (6.5)
	≥3	113 (91.9)
Number of snacks	None	20 (16.3)
	1	27 (22.0)
	2	27 (22.0)
	≥3	11 (8.9)
Difficulty in eating	Nausea/vomiting	27 (22.0)
Difficulty in eating	Nausea/vomiting	27 (22.0)
	Anorexia	55 (44.7)
	Abdominal discomfort	16 (13.0)
	Stomatitis	10 (8.1)
	None	5 (4.1)
	Others	3 (2.4)
	No answer	7 (5.7)
Change in oral intake	Yes	98 (79.7)
	No	16 (13.0)
	No answer	9 (7.3)
Time to increase oral intake	No change	15 (12.2)
	≥3 days	22 (17.9)
	≥1 week	39 (31.7)
	≥2 weeks	35 (28.4)
	≥3 weeks	7 (5.7)
	≥4 weeks	5 (4.1)
Diet education	Yes	64 (52.0)
	No	59 (48.0)

%IBW= Percent ideal body weight.

Table 2.

Knowledge and Compliance of Neutropenic Diet (N =123)

Variables	Categories	n	Knowleedge		Compliaance
Variables	Categories	n	M ± SD	Correct answers (%)	M ± SD	Percent scale
Permitted	Fruits and vegetables	5	3.54 ± 1.22	70.7	12.72 ± 3.71	63.6
	Meat and fish	5	2.52 ± 1.44	50.4	9.62 ± 3.16	48.1
	Dairy products	3	2.46 ± 0.72	82.1	7.96 ± 2.35	66.3
	Beverages, snacks and cereals	6	2.80 ± 1.51	46.6	10.63 ± 3.59	44.3
	Subtotal	19	11.32 ± 3.59	59.6	40.93 ± 10.05	53.9
Not permitted	Fruits and vegetables	6	3.78 ± 2.00	63.0	20.52 ± 4.53	85.5
	Meat, Fish and shellfish	4	2.84 ± 1.12	70.9	14.09 ± 2.43	88.1
	Dairy products	5	2.91 ± 1.71	58.2	16.82 ± 3.37	84.1
	Beverages, snacks and cereals	3	1.67 ± 1.14	55.8	10.46 ± 1.88	87.1
	Subtotal	18	11.20 ± 5.18	62.2	61.89 ± 10.42	86.0
Total		37	22.52 ± 6.02	60.9	102.81 ± 9.99	69.5

Table 3.

Knowledge and Compliance of Questionnaire Items about Neutropenic Diet (N =123)

Variables	Categories	Permitted		Not permitted
		Knowledge	Compliance	Knowledge	Compliance
		Correct answer (%)	Percent scale	Correct answer (%)	Percent scale
Fruits and vegetables	Fresh fruits with skin removed or peeled off	75.6	65.7
	Sterilized canned juice, canned fruits and vegetables	71.5	57.5
	Cooked seaweed or laver	89.4	74.5
	Uncooked oil, olive oil	60.2	60.5
	Add sesame seeds, sesame oil or herbs	56.9	59.5
	Washed fresh fruits			64.2	80.0
	Uncooked sherbet			64.2	93.7
	Uncooked dried fruits (ex. raisins)			59.3	89.7
	Washed fresh vegetables			61.8	77.7
	Uncooked Kimchi			70.7	86.5
	Pickle vegetables such as pickle, radish.			57.7	85.7
Meat and fish	Cooked deli meat (ham)	45.5	42.0
	Cooked intestine or liver	28.5	34.2
	Pizza with meat	36.6	39.2
	Cooked frozen instant foods	47.2	45.7
	Cooked fish	94.3	79.2
	Steamed dried meat such as jerky, prawns			61.0	89.7
	Raw fish or fresh meat			92.7	95.2
	Raw eggs			88.6	95.0
	Cooked shellfish (ex. cuttlefish, octopus, shrimp, abalone)			41.5	72.2
Dairy	Sterilized milk or pasteurized milk products	87.0	66.0
	Cooked pudding	66.7	55.0
	Cooked soybean soup or miso soup Soybean noodle	92.7	78.0	43.1	76.0
	Packaged raw tofu			53.7	85.7
	Miso paste or bean paste			55.3	75.5
	Fresh cream cake, cheese, butter, margarine, mayonnaise			72.4	92.0
	Soft ice cream, milkshake			66.7	91.0
Beverages, snacks and cereals	Boiled tea or coffee	82.1	60.7
	Drinks packed in bottles or cans	65.0	53.2
	Jam, jelly, syrup	22.0	33.7
	Chocolate, candy, gum	42.3	41.7
	Instant food (ex. cup noodles, retort)	25.2	35.7
	Powdered cereals Fresh honey	43.1	40.7	54.5	87.5
	Nuts including peanuts Ice			41.5	81.5
	Ice cream bar			71.5	92.2

Table 4.

Knowledge and Co ompliance of Neutropenic Diet by Subjects Characteristics (N =123)

Characteristics	Categories	Knowledge		Compliance
Characteristics	Categories	M ± SD	t or F (p) Scheffé	M ± SD	t or F (p) Scheffé
Gender	Male	21.73 ± 6.22	−1.69	102.30 ± 9.34	−0.65
	Female	23.57 ± 5.62	(.094)	103.49 ± 10.84	(.515)
Age (year)	20~39^a	25.33 ± 6.37	3.04	108.62 ± 13.17	4.53
	40~59^b	22.33 ± 5.10	(.052)	101.67 ± 9.67	(.013)
	≥ 60 ^c	21.63 ± 6.34		101.58 ± 8.17	b, c＜ a
Education level	≤ Middle school^a	20.58 ± 6.66	4.32	100.78 ± 8.12	2.06
	High school^b	22.75 ± 5.62	(.015)	102.75 ± 10.49	(.131)
	≥ College^c	24.70 ± 5.10	a＜ b, c	105.63 ± 10.95
Religion	Yes	22.64 ± 5.75	0.33	102.57 ± 9.82	−0.39
	No	22.26 ± 6.63	(.742)	103.33 ± 10.46	(.696)
Inmate	Yes	25.00 ± 6.96	1.91	108.06 ± 12.72	2.46
	No	22.10 ± 5.77	(.058)	101.91 ± 9.22	(.015)
Employment status	Employed	22.29 ± 7.03	−0.39	104.88 ± 11.09	2.20
	Unemployed	22.72 ± 4.99	(.694)	100.97 ± 8.57	(.030)
Monthly income	＜100^a	20.00 ± 5.84	4.51	99.95 ± 7.07	2.03
(10,000 won)	100~＜200^b	24.65 ± 6.41	(.005)	105.20 ± 11.87	(.114)
	200~＜300^c	23.84 ± 5.87	a＜ c, d＜ b	103.65 ± 10.86
	≥ 300^d	23.50 ± 5.04		104.68 ± 10.92
Diagnosis	Leukemia^a	18.80 ± 8.50	3.48	100.50 ± 10.78	1.05
	Lymphoma^b	22.28 ± 5.00	(.018)	101.24 ± 8.20	(.375)
	Multiple Myeloma^c	24.50 ± 6.04	a＜ b, c, d	104.84 ± 10.77
	Myelodysplastic syndrome^d		21.52 ± 5.38	102.20 ± 9.90
No. of chemotherapy cycle	≤ 3rd	22.84 ± 6.15	1.03	103.87 ± 9.74	0.68
	4~6th	22.67 ± 5.96	(.384)	102.74 ± 9.46	(.565)
	7~10th	20.42 ± 6.01		100.00 ± 10.91
	≥ 11th	23.69 ± 5.79		103.38 ± 11.25
Serum albumin (g/dL)	＜3.5	23.00 ± 6.37	0.32	105.90 ± 9.75	1.46
	≥ 3.5	22.53 ± 5.91	(.749)	102.37 ± 9.89	(.146)
%IBW (%)	70~＜80	22.60 ± 8.85	0.13	111.60 ± 13.90	2.60
	80~＜90	23.55 ± 3.08	(.875)	105.18 ± 11.52	(.079)
	≥ 90	22.57 ± 6.00		102.23 ± 9.11
Cooking	Self ^a	21.54 ± 6.01	2.98	99.89 ± 6.85	2.57
	Spouse^b	21.21 ± 5.81	(.010)	102.02 ± 9.23	(.023)
	Child^c	22.80 ± 5.92		103.10 ± 7.98	a＜ b, c, d＜ e
	Siblings^d	24.67 ± 2.25		105.17 ± 10.87
	Others^e	19.00 ± 1.41		99.50 ± 19.09
Time increased the oral intake	≥ 3 days^a	22.82 ± 4.37	1.50	99.27 ± 8.02	3.26
	≥ 1 week^b	23.83 ± 5.76	(.209)	102.44 ± 9.42	(.015)
	≥ 2 weeks^c	22.81 ± 6.47		106.72 ± 11.00	a＜ b, c, d＜ e
	≥ 3 weeks^d	18.67 ± 8.50		108.67 ± 10.50
	≥ 4 weeks^e	28.00 ± 4.06		113.40 ± 15.85
Change in oral intake	Yes	23.33 ± 5.80	2.21	103.88 ± 10.53	−2.48
	No	19.94 ± 4.85	(.029)	99.13 ± 6.37	(.019)
Diet education	Yes	24.94 ± 4.96	5.09	104.95 ± 10.86	2.53
	No	19.90 ± 6.00	(＜.001)	100.49 ± 8.44	(.013)

%IBW= Percent ideal body weigh ht.

Table 5.

Correlation between Knowledge and Compliance of Neutropenic Diet (N =123)

Knowledge	Total
Knowledge	r (p)
Compliance	.53 (＜.001)

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