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To the Editor: In their Perspectives on Care at the Close of Life, Drs Boockvar and Meier¹ discuss palliative care for frail older adults and state that "relief of discomfort and enhancement of quality of life is highly appropriate." They recommend considering megestrol as a treatment and cite Reuben et al²; however, that study did not find a statistically significant effect of megestrol acetate on serum albumin levels or clinical end points, such as weight, functional status, or health-related quality of life. They also cite Yeh et al,³ who found no difference in weight change until months after treatment was stopped, no difference in depression scores, and a 3-point difference on a 99-point scale of sense of well-being. As Boockvar and Meier note, the drug is toxic. I believe that the current best evidence indicates that megestrol has no role in the care, palliative or otherwise, of frail older . . . [Full Text of this Article]

Thomas E. Finucane, MD
tfinucan@jhmi.edu
Division of Geriatric Medicine and Gerontology
Johns Hopkins Bayview Medical Center
Baltimore, Md

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