Shortages of cancer drugs are forcing doctors to decide which patients to receive treatment

Just six weeks ago, Greg DeStefano started a new combination of chemotherapy. The 50-year-old, from Northbrook, Illinois, had recently been diagnosed with his fourth round of cancer and doctors hoped the drug would cure the tumors growing in his neck.

DeStefano was responding well, but then, in late May, he got a call from his doctor and was told that one of the three drugs he was taking, carboplatin, was in global shortage and because of the way the hospital had to prioritize treatments, he would no longer be qualified to receive it.

“We are frustrated that not only are we dealing with cancer, but we are now facing a shortage of pretty critical drugs,” DeStefano told ABC News.

DeStefano’s experience is similar to thousands of patients in the United States who have delayed treatment or been unable to receive treatment due to cancer drug shortages.

At least 11 cancer drugs are currently in short supply, according to an ABC News analysis of data from the U.S. Food and Drug Administration.

Among these are carboplatin, used to treat ovarian and head and neck cancer; azacitidine, which treats a form of leukemia; and dacarbazine, used to treat skin cancer.

“We’ve experienced drug shortages, intermittently, my entire career, it’s always been a challenge,” Julie Kennerly-Shah, associate director of pharmacy at the Ohio State University Comprehensive Cancer Center, told ABC News. “The last six months have been the busiest of my career managing the drug shortage in the cancer population.”

He continued, “As you can imagine, it’s extremely frustrating knowing you have a drug that can potentially cure a cancer patient or extend their life, and knowing you may not have enough to cure that patient.”

Last month, the American Cancer Society issued a warning that chemotherapy drugs had returned to the list of top five drug classes affected by shortages and warned that this could have a devastating effect on patients.

Some hospitals and clinics are completely off drugs. In others, doctors are forced to ration cancer drugs or evaluate which patients get the drugs first.

“We’re on sort of life support, whether or not we’re going to get enough medications, and we’ve internally operationalized various ways to prioritize who gets which medications,” Dr. Mark Einstein, an ob-gyn oncologist at the University Hospital in Newark, New Jersey, told ABC News. “Especially when there are limited or no alternatives.”

DeStefano said this shortage means that unless he chooses a different course of treatment, which involves chemotherapy and then a resection or removal of the tumor, he won’t be eligible to receive the drug.

However, because he’s had multiple surgeries in the past due to previous bouts of cancer, the surgery has more risks for him, his wife, Mindy DeStefano, told ABC News.

“That’s the crux of our frustration, that he’s got a therapy and a treatment that works and now because of the way they have to categorize and prioritize patients, he’s now no longer able to access this drug,” he said. said.

Doctors say there are a number of factors behind the nationwide shortages, including low profit margins for generic versions of these drugs, as well as labor and supply chain issues.

“All these drugs that we have a shortage of, they’re all old, generic chemotherapy drugs that are quite cheap in relation to cancer drugs,” Dr. Dr. Hanna Sanoff, a gastrointestinal medical oncologist at the University of North Carolina Lineberger Comprehensive Cancer Center. he told ABC News. “And so, the economic margin here is just much smaller for drug makers.”

He continued, ‘A lot of our supply comes from India and China, and there have been some recent closures of a couple of major generic suppliers and so it was already kind of a weak supply chain that then was disrupted by the closure of the plants.”

For short-term solutions, the Society of Gynecologic Oncology currently recommends minimizing ordering of shortage drugs if another drug with comparable efficacy and safety is available, and using the lowest possible dose and longest interval between doses acceptable.

Kennerly-Shah said patients at his center have switched to alternative drugs or there have been operational changes.

“Rounding the dose is a frequent practice, so rounding to the nearest vial size, typically within a 10 percent range, so you don’t waste any more leftover medication by opening an extra vial,” he said.

For long-term solutions, doctors are calling for more transparency from companies about when additional shipments can be expected, potentially offering incentives for generic drug makers or even seeing if the FDA can find ways to potentially extend the shelf life of drugs critics.

Greg DeStefano and Mindy DeStefano said they have potentially found another local hospital in Chicago with carboplatin supply, but need to have more conversations to see if it qualifies for treatment.

“This is life and death,” he said. “This is not symptom relief; it’s life or death. And it’s really frustrating that in this country we have to try and find a drug that technically should be available. I mean, it’s a life and death drug.”

#Shortages #cancer #drugs #forcing #doctors #decide #patients #receive #treatment

Leave a Comment