Comprehensive cancer centers are running low on supplies of critical treatments

Comprehensive cancer centers are facing shortages of critical treatments.

Thirty-one cancer centers surveyed by the National Comprehensive Cancer Network (NCCN) in August said they were experiencing a shortage of at least one cancer medication, and about 23% reported shortages of five or more medicines. The NCCN, a nonprofit group that represents 34 comprehensive cancer centers nationwide, published the results on Sept. 10.

The economics of manufacturing generic medicines are a major contributor for drug shortages, William Padula, a senior scholar at the University of Southern California’s Schaeffer Institute for Public Policy and Government Service, told Healthcare Brew.

“When a generic manufacturer enters the market, they start competing on lowering the price as much as possible,” Padula said. “As competition increases, some exit the market—because the profitability of these generics just becomes very low—and when they exit the market, then you have an immediate shortage.”

Healthcare Brew reached out to the Association for Accessible Medicines, a trade group representing generic drugmakers, but did not hear back by publication.

The most severe shortages. Ifosfamide, a generic chemotherapy drug used to treat several cancers, including testicular, uterine, and bladder, was reported by 94% of the cancer centers as being in shortage.

The next most common shortage was carboplatin—a generic chemotherapy used primarily for advanced ovarian cancer—which was reported by 71% of the cancer centers.

Other commonly reported shortages included cisplatin, a chemotherapy used for several cancers, including bladder, head, and neck, and Bacillus Calmette-Guérin, an immunotherapy for bladder cancer.

All of these drugs are used as first-line treatments for various types of cancer, meaning they’re accepted as the best treatment option available.

Some of the medications have been in short supply for years.

“It is disheartening that we remain in the same situation, including recurring or continued shortages of some drugs, despite years of raising the alarm and providing insight about this disruptive and dangerous issue for cancer care in America,” Crystal Denlinger, NCCN’s CEO, said in a statement.

Saving supplies. Because of the shortages, many cancer centers reported taking steps to conserve supplies.

Some strategies include using the minimum recommended dose of a medication. If a medicine’s recommended dosing range was 4mg/mL to 5mg/mL, for example, the cancer centers may give patients 4mg/mL, according to the survey.

Similarly, another strategy was to use the maximum recommended amount of time between treatments. If a medicine was recommended to be given, say, every three to four weeks, the cancer centers may administer them every four weeks to stretch the supplies further, the survey reported.

There are risks to mitigation strategies because care should be “as standardized as possible,” Padula said.

“When you create that variability in patient care, you’re departing from guideline-based care, and that’s what leads to negative consequences for the patient,” he said. “Survival rates will be impacted, cure rates will be impacted, and that’s not good.”

By using such mitigation strategies, 61% of the cancer centers reported they were able to treat all patients receiving the drugs in shortage. Additionally, 32% said they were able to treat patients without having to use any mitigation strategies. However, 7% reported they were not able to treat all patients.

For those that had to modify patients’ treatment plans, 66% of respondents reported they had to re-obtain prior authorization, and of those, 17% said it led to treatment delays, while 69% said it did not cause delays.

Beyond patient care, 39% of the cancer centers also reported the drug shortages impacted their ability to conduct clinical trials. If a cancer center only has enough of a drug for the experimental group and not the control group, for example, it creates an imbalance and the study gets delayed, Padula said.

“The trickle-down effect of this whole constraint with availability of drugs can certainly have a long-term impact on the advancement in science,” he said.