John R. Wingard, MD

As noted by Back,[1] the primarygoals of effective patient-physician communicationare to enhance patient understandingof the illness, to improvedecision-making, and to facilitate patientadjustment. These three goalsare sensible and important concernsof the communication dyad. A numberof studies have examined variousaspects of the communication processand the factors that influence communicationoutcomes, and a few evenhave tested interventions to improvephysician communication skills. However,there remains a dearth of studiesthat examine communication effectson the three major goals articulatedabove and that evaluate the effectivenessof communication skill interventionsin influencing patient outcomes.

One of the major challenges facing oncologists today is invasive fungal infection. Difficult to diagnose and deadly when missed, invasive fungal infection-primarily by Candida and Aspergillus organisms-is the major infectious cause of death associated with chemotherapy-induced myelosuppression. In this review, the problem will be described and evidence-based approaches to management, including assessment for risk factors and empiric antifungal therapy, will be discussed. Finally, the future of diagnostic and therapeutic strategies for protecting the immunocompromised patient will be considered. [ONCOLOGY 15(3):351-369, 2001]

Improvements in outcome following treatment for acute leukemia have derived from various sources: the introduction of new chemotherapeutic agents; the development of effective drug combinations; the use of multistage approaches to induction consolidation, and maintenance therapy to optimize durable control; and advances in supportive care to reduce treatment-related mortality. Certainly, infectious morbidity and mortality have plagued effective antileukemic therapy for many years. As a result, control of infectious complications has been an important area of clinical study. Through the concerted efforts of many clinical investigators, progress has occurred, and, today, infectious mortality is an infrequent complication of antileukemic therapy.