Letters Section Editor: Robert M. Golub, MD, Senior Editor.
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 adults.
Finucane TE. Frail Older Adults and Palliative Care. JAMA. 2007;297(11):1193-1195. doi:10.1001/jama.297.11.1193-b