Oncologists grapple with ongoing cancer drug shortages: 7 notes

Oncologists are grappling with chemotherapy drug shortages, which have led many to make difficult triage decisions on which patients receive the drugs first, Medscape Medical News reported Nov. 3.

Chemotherapy drugs are among the top five drug classes with active shortages. There are currently 22 in shortage in the U.S., according to the American Society of Health-System Pharmacists. 

Faced with ongoing scarcity, some oncologists have begun reserving the drugs for patients with more promising prognoses over those for whom treatment would merely extend life, Kathleen Murphy, RN, executive director of Nursing Services at Tennessee Oncology, told Medscape.

Here are seven things to know:

1. In a May Medscape poll of 140 oncologists, 45% said recent shortages of certain chemotherapies have led to “severe negative impacts” on the quality of care provided by their practice. Forty-two percent also said these shortages had a severe negative impact on patient outcomes.

2. Shortages of carboplatin and cisplatin were identified as the most problematic, followed by shortages of antimetabolites methotrexate and fluorouracil and limited access to saline.

3. More than half of oncology practices report being affected by shortages across 23 cancer drugs. 

4. All practices reported having strategies to mitigate shortage impacts; however, half of practices reported that shortages created ethical dilemmas around drug allocations and enrolling patients in clinical trials.

5. Drug shortages do not always mean that drugs are unavailable. Often, supplies may be available through other manufacturers or in other doses. Hospitals and practices use a number of mitigation strategies to relieve negative impacts on patient care during a shortage, including reaching out to other facilities to obtain drugs, switching patients to more expensive oral therapies, buying extra supply, minimizing waste when drugs are mixed and turning to subject matter experts to prioritize patients and find drug alternatives.

6. Cancer drug shortages most often occur among injectable drugs and due to the complexity of manufacturing and low profit margins. Some generic injectable drugs are produced at a negative margin, and manufacturers only continue making them to fill a production line.

7. The American Society of Clinical Oncology, among other organizations, is advocating for changes to the economics surrounding generic sterile injectable cancer drugs. These include a multi-pronged approach to create an incentive for reliable and quality manufacturing and supporting a value-based payment system.