In the past 20 years there has been considerable growth in the provision of palliative care services. The shift in emphasis from hospice and hospital care to the development of community services has been significant. This enables people to be cared for at home and is in keeping with Government agenda. While this may be beneficial for the patient and fit in with the wishes of the family, it is likely to put heavy demands on the coping resources of individual carers. The views of service users are of paramount importance when discussing service evaluation and patient, family and carer empowerment. This research presents the findings of an evaluation of the domiciliary occupational therapy service provided for patients in the palliative stage of cancer care in North and West Belfast from the perspective of the patients and carers. For the purpose of this study, the palliative stage of cancer care is defined as the point from which the patient is no longer responsive to curative treatment, until death. A sample of 30 patients and their primary informal carers were selected using purposive sampling. A structured interview was carried out with both the patients and their carers to obtain views. Results suggest that although both patients and their carers value the service provided and report high levels of satisfaction, there are gaps identified in service provision and a lack of clear information among patients and their carers about the role of the occupational therapist and the range of services they can provide. There is a need to build upon the good work being done by domiciliary occupational therapists in the area of palliative cancer care and increase education and resources to ensure that a patient-centred, holistic, approach to care is used, addressing both the needs of the patient and their carers.

Background:  For patients with a diagnosis of head and neck cancer, oral nutrition may not provide adequate nutrition during radical radiotherapy or chemoradiation treatment, resulting in enteral feeding initiation. Enteral feeding may be delivered via a nasogastric tube or by a gastrostomy tube. The present study aimed to determine how different treatment modalities impact on requirement for enteral feeding and which method of enteral feeding provided the most benefit to the patient, as demonstrated by weight loss and the number of unscheduled radiotherapy treatment interruptions. Methods:  Patients who were treated with radical radiotherapy or chemoradiation between January 2004 and June 2007 were reviewed retrospectively (n = 196, male = 149, female = 47). Data were collected on demographics, diagnosis, T and N classification, nutritional status, unscheduled radiotherapy treatment interruptions, and type and duration of enteral feeding. Subjects were divided into three subgroups depending on the treatment received. Comparisons were then made between methods of enteral feeding. Results:  Combined modality treatment (Induction Chemotherapy and Chemoradiation) results in a higher proportion of patients requiring enteral feeding (66–71% compared to 12% for radiotherapy). Patients fed via a prophylactic percutaneous endoscopic gastrostomy lost the least amount of weight during treatment (−4.6% to +1.4%), although the method of enteral feeding did not statistically influence weight difference at the end of treatment. The enteral feeding method did not influence unscheduled radiotherapy treatment interruptions. Conclusions:  Combined modality treatment results in a greater requirement for enteral feeding, with these patient groups having the greatest weight loss. The findings obtained in the present study indicate that the method of enteral feeding did not statistically influence weight loss at the end of treatment or unscheduled radiotherapy treatment interruptions.

S-y AQ4N (l,4-bLs-q25ddimthyai oo y}amin5dydroxy-anthrane-9,10-dione) is a novel alkylaminoanthraquinone N-oxide which, on reducin, forms a stable DNA affinic cytotoxi compound AQ4. The The failure to cure tumours with radiotherapy and chemotherapy has been attributed in part to the presence of treatment-resistant subpopulations of hypoxic tumour cells (Bush et at., 1978). Bioreductive agents provide a novel approach to this problem: reduction of the prodrug within a hypoxic cell to produce a cytotoxic metabolite should selectively target this sub population within tumours. Since normal tissus contain few, if any, poorly oxygenated cells, systemic reductive activation and its attendant toxicity should be minimal. Several classe of bioreductive agents have been described, icluding the nitroimidazoles, benzotriazene di-N-oXides and mitosenes (Workman, 1992). Using a different class of compounds, i.e. the anthraquinones, we have developed a novel alkylamnoanthraquinone N-oxide, AQ4N (1,4-bis-{[2-(di-methylamino-N-oxide)ethylarmino}5,8-dihydroxyanthracene-9,10-ione), which is susceptible to reduction under hypoxic conditions (Patterson, 1993). AQ4N is a weak DNA-binding agent and weak topoisomerase H inhibitor, critically, the electrically neutral N-oxide function prevents stable binding to the DNA helix (Patterson, 1993). In contrast, the reduction product of AQ4N, i.e. AQ4 (1,4-bis-{[2-(dimethylamino) ethylnamino}5,8-dihydroxyanthracene-9,10-dione) (Figure 1), is a cationic compound with high affinity for DNA. Interaction of AQ4 with DNA is facilitated by the planar, eletrondeficient antraquinone chromophore intercalating between adjcent DNA bases. Tlis complex is further stabiised by electrostatic interactions and hydrogen bonding with the deoxyribose phosphate backbone, as has been observed for similar anthraquinones (Denny and Wakelin, 1990 al., 1992). This will allow metabolism of the drug in cells which will contribute, when the hypoxic stimulus is removed, to the main growth frction within the tumour. Secondly, the drug can be combined with an agent which is selectively toxic to well-oxygenated cells to evahuate the effect of targeting the two subpopulations of cells (Brown and Lemmon, 1991;Grau and Overgaard, 1991). We have used both these approaches to study the effect of AQ4N on tumour growth in vivo. Firstly, we tested the anti-tumour effect of AQ4N when combined with hypobaric hypoxia. Following this we combined AQ4N with radiation as both single and fractionated doses. Materiak an mth Tumour systemThe T50/80 tumour is a poorly differentiated mammary carcinoma which arose in a B6D2FI mouse. Tumour and breeding colonies for mice were obtained from Dr JV Moore, Paterson Laboratory, Christie Hospital, Manchster, UK.Male B6D2FI mice aged 8-12 weeks were used for all studies, which were carried out in accordance with the UK. Animals (Scientific Procedures) Act 1986. The tumour has been maintained by intadermal passage for up to ten passages and then re-establshed from frozm stock. Tumour brei (0.05 ml) w...

SummaryThe ability of the bioreductive drugs AQ4N and tirapazamine to enhance the anti-tumour effect of cyclophosphamide was assessed in three murine tumour models. In male BDF mice implanted with the T50/80 mammary carcinoma, AQ4N (50-150 mg kg -1 ) in combination with cyclophosphamide (100 mg kg -1 ) produced an effect equivalent to a single 200 mg kg -1 dose of cyclophosphamide. Tirapazamine (25 mg kg -1 ) in combination with cyclophosphamide (100 mg kg -1 ) produced an effect equivalent to a single 150 mg kg -1 dose of cyclophosphamide. In C3H mice implanted with the SCCVII or RIF-1 tumours, enhancement of tumour cell killing was found with both drugs in combination with cyclophosphamide (50-200 mg kg -1 ); AQ4N (50-200 mg kg -1 ) produced a more effective combination than tirapazamine (12.5-50 mg kg -1 ). Unlike tirapazamine, which showed a significant increase in toxicity to bone marrow cells, the combination of AQ4N (100 mg kg -1 ) 6 h prior to cyclophosphamide (100 mg kg -1 ) resulted in no additional toxicity towards bone marrow cells compared to that caused by cyclophosphamide alone. In conclusion, AQ4N gave a superior anti-tumour effect compared to tirapazamine when administered with a single dose of cyclophosphamide (100 mg kg -1 ).

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