Consensus guidelines for improving patients' understanding of invasive fungal disease and related risk prevention in the haematology/oncology setting, 2021

Abstract

Patients with invasive fungal disease (IFD) are at significant risk of morbidity and mortality. A productive partnership between patients, their carers/families, and the multidisciplinary team managing the infection and any underlying conditions, is essential. Sharing information and addressing knowledge gaps are required to ensure those at risk of IFD avoid infection, while those with suspected or confirmed infection optimise their therapy and avoid toxicities. This new addition to the Australian and New Zealand consensus guidelines for the management of IFD and antifungal use in the haematology/oncology setting outlines the key information needs of patients and their carers/families. It specifically addresses risk factor reduction, antifungal agents and adherence, and the risks and benefits of complementary and alternative therapies. Knowledge gaps are also identified to help inform the future research agenda.

Approach to diagnostic evaluation and prevention of invasive fungal disease in patients prior to allogeneic hematopoietic stem cell transplant

“…to improve outcomes across a range of medical specialties. 110 Given the impact of various environmental exposures on the development of IFD, it is important that the risks of each, and how to minimize them, are communicated. Additionally, it must be appreciated that there are many reasons for nonadherence to recommended therapy, including complexity of medication regimens, poor health literacy, language barriers, mental health issues, lack of social supports or financial strain.…”

“…Additionally, it must be appreciated that there are many reasons for nonadherence to recommended therapy, including complexity of medication regimens, poor health literacy, language barriers, mental health issues, lack of social supports or financial strain. 110 For patients to take appropriate measures to minimize risk of environmental exposures to fungal pathogens, they must first have a thorough understanding of where these risks lie. Mold spores are ubiquitous in the environment, and with this in mind, there are limited formal recommendations on how to avoid spores in the community, with most recommendations derived from low level evidence or expert opinion.…”

“…110 Despite this, patients should be advised to avoid uncooked herbs, soft cheeses, cold brewed tea or coffee, fermented drinks and probiotics. 110 Additionally, patients should adhere to standard hygiene practices of washing hands thoroughly prior to food preparation, and take care to wash fresh produce and peel any rough-skinned produce. 110 Activities such as gardening, composting, and cleaning dusty environments should also be avoided where possible.…”

“…110 Additionally, patients should adhere to standard hygiene practices of washing hands thoroughly prior to food preparation, and take care to wash fresh produce and peel any rough-skinned produce. 110 Activities such as gardening, composting, and cleaning dusty environments should also be avoided where possible. If this is not achievable due to a persons' domestic, occupational circumstances, or personal preference, then appropriate personal protective equipment should be utilized.…”

“…Due to the negligible protection of a surgical mask against spore inhalation, a P2/N95 respirator should be worn if the exposure risk is present. 110 Most patients undergoing pretransplant work up will have a form of long-term vascular access. All patients should receive appropriate education regarding the care of these devices, including how to safely access them (if applicable), routine dressing care, and being aware of early signs of infection.…”