A recent report on invasive fungal infections (IFIs) has revealed that concerns among oncology nurses about IFIs in their cancer patients are well-founded. The report, released by the publishers of ONSEdge, also provides additional information on the likely cause of the increase, identifies patients who are most at risk, and describes what can be done to prevent the infections.
The Knowledge Report: Invasive Fungal Infections, the white paper that reviews the survey findings, revealed that the rising concern among oncology nurses for their patients’ risk of IFIs may very well be justified. According to background information provided in the white paper, the incidence of IFIs has risen sharply in the past 2 decades mostly because of the immunosuppression experienced by the larger numbers of patients undergoing hematopoietic stem cell transplant (HSCT) as treatment for cancer. Because these high-risk patients have an increased susceptibility to bacterial and viral infections, oncology nurses have become increasingly concerned about the significant number of opportunistic infections that may arise due to fungi. In a study published in Clinical Infectious Diseases (2010 Apr 15;50(8):1091-100), researchers have shown that among patients who have received HSCT, the Aspergillus species of mold is the most common cause of IFI.
As demonstrated by the results of the survey, the risk of IFIs has become apparent to oncology nurses. The findings revealed that 68% of respondents agreed with the statement, “I am increasingly concerned about invasive fungal infections as a complication in my high-risk patients.”
According to background information provided in the report, patient populations as identified by evidence-based guidelines include
- Those with profound, prolonged neutropenia (low WBC counts)
- Those with acute leukemia or myelodysplastic syndromes
- Allogenic (non-self) hematopoietic stem cell transplantation (HSCT) recipients
- Patients with graft-versus-host-disease (GVHD, a frequent complication of HSCT)
- Autologous HSCT recipients with mucositis.
The survey also revealed that oncology nurses are not only concerned about IFIs, they also understand the risk of IFIs in certain oncology patient populations. Specifically, 70% of respondents indicated that patients with myelodysplastic syndromes who were neutropenic were at high to very high risk of IFIs. In addition, 79% indicated that patients with acute myelogenous leukemia who were neutropenic were at high to very high risk. Furthermore, investigators reported that 66% believed that patients who were stem cell transplant recipients and who developed GVHD were also at high to very high risk for IFIs.
The white paper also reviewed the use of prophylactic agents, a method that 77% of survey respondents believe to be the best approach to manage the risk of developing IFIs. In a study published the Journal of Clinical Oncology (2007;25(34):5471), researchers reported that the introduction of antifungal agents for the prevention of infection significantly reduced the incidence of IFIs by 50%, with antifungal prophylaxis decreasing overall mortality by 21% and fungal-related deaths by 45%.
The nurses indicated that their primary roles in discussing IFI prophylaxis in patients and caregivers include discussing
- The administration of the antifungal agent selected
- Symptoms that a patient or caregiver should report
- The importance of prophylaxis with specific antifungal agents
- Environmental factors to change or avoid during treatment in order to minimize exposure to IFIs.
“The encouraging news, despite the rising incidence of aspergillosis, is that there are effective methods for preventing and treating IFIs,” concluded the report’s authors. “A recent review noted several studies that are demonstrating improved outcomes in preventing and treating Aspergillus infections, and oncology nurses are playing an important role in this process.” ONA