A prospective study of the place of death of 160 patients referred to a hospital support team was carried out. Of these patients 62% died in hospital, 26% at home and 12% in a hospice. Overall, 56% of patients (90) were able to express a preference for place of death; 48 patients wished to die at home and 26 wanted to be cared for in a hospice. 71 % of these patients achieved their choice but the remainder became too unwell to transfer and died in hospital. Thirteen patients chose to die in hospital; other reasons for death in hospital included unexpected deterioration while undergoing active treatment or investigations (33), relatives unable to cope with home care (27) and late presentation precluding transfer (12). The lack of choice for some patients dying of nonmalignant disorders is highlighted and attention is drawn to the distress of patients sent to a hospice against their choice.

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Cytokines have a major role in promoting the growth and spread of cancers. Elevated levels of several cytokines have been described in cancer patients. Evidence from animal and human studies suggests that cytokines may contribute to a wide range of symptoms in advanced cancer, including: asthenia, pain, drowsiness, cognitive failure, agitated delirium, autonomic dysfunction, anorexia, cachexia, fever and metabolic abnormalities. Considerable effort is being directed at finding anticytokine treatments, raising the possibility of new options for symptoms that are currently difficult to control.

The care given to 26 dying patients, and their families, being nursed in a hospital where there was no specific terminal care facility was studied. These patients were dying from both malignant and non-malignant disease. Anorexia, sleeplessness, coated or infected mouths, pain, and pressure sores were seen in half of the patients. Fear about caring for the patient at home and lack of information were the problems most frequently identified by the relatives.As a result of this study a multidisciplinary team specialising in symptom control and supportive care has been established. On average half of the total number of patients dying from cancer in the hospital are supported by the team. The number of complaints from relatives of dying patients has been drastically reduced since the team was formed. IntroductionOver the past 15 years hospices have emerged all over Britain, becoming places of excellence in relieving distress in the dying patient. Hospices, however, cannot cater for all the dying, and in most cases priority is given to the patient with cancer.Recent statistics show that 60% of deaths from cancer still occur

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