Supplies of cancer drugs unpredictable

Cancer drug shortages are forcing treatment changes and delays that for some patients have led to worse outcomes, more therapy-related complications and higher costs, according to a national survey of health professionals published March 21.

According to the results of the survey, conducted by the Hematology/Oncology Pharmacy Association, of the 243 individual respondents, 98 percent reported having dealt with a shortage of at least one chemotherapy agent or other essential cancer-related drug in the previous 12 months.

“Drug supplies remain unpredictable, and serious problems persist,” said James Hoffman, PharmD, senior author of the results study and an associate member of St. Jude Children’s Research Hospital Department of Pharmaceutical Sciences and the hospital's medication outcomes and safety officer, in a press release.

The survey focuses on the impact of cancer-related drug shortages. Results will be published in the April 1 edition of the American Journal of Health-System Pharmacy. The study was funded in part by a grant from the National Institutes of Health and ALSAC, the fund-raising arm of St. Jude Children’s Research Hospital.

The survey also found that 93 percent of participants reported that shortages forced delays in chemotherapy administration or other changes in cancer drug therapy.

Overall, 16 percent of respondents tied shortages to adverse patient outcomes, including disease progression or more treatment-related complications. One institution linked a patient's death to a shortage-related medication mistake.

The survey found shortages increase healthcare costs as scarcity drives up the price and requires staff time to manage the problem. About one-third of institutions in the survey reported pharmacy staff spent at least 20 hours each week working on issues related to the drug shortage. That included time spent trying to find scarce medications to purchase or identify alternatives. Eighty-five percent of respondents reported shortages led to higher medical costs.

Drug shortages also disrupted the clinical trials that are essential for developing new cancer treatments. The survey found that shortages forced 44 percent of institutions to either halt or delay enrollment in clinical trials. The problem also led some providers to change or omit medications.

The drugs most frequently reported in the survey as being in short supply were fluorouracil, leucovorin, liposomal doxorubicin and paclitaxel. Such shortages hit patients battling ovarian, breast and colorectal cancers particularly hard. For some patients, the survey found shortages meant traveling to other institutions for treatment or receiving alternative medications. For other patients, it meant treatment was delayed, or continued with either lower doses of the missing drugs or without the drugs at all.

“To cure cancer patients we must often use complex treatment regimens, and shortages add unnecessary complexity. Unlike medications for other diseases, there are few, if any, therapeutically equivalent alternatives available for many oncology drugs in short supply,” Hoffman said in the press release.

In February, the University of Utah Drug Information Service, which monitors drug shortages and advises how to manage them, tracked national and regional shortages of more than 320 drugs, the highest number since 2010.

In 2012, legislation gave the U.S. Food and Drug Administration additional tools to prevent and ease drug shortages, including requiring manufacturers to report anticipated supply problems of key medications. Despite the legislation, Hoffman said in the press release, “Drug supplies remain unpredictable and serious problems persist.”