National Survey on the Effect of Oncology Drug Shortages in Clinical Practice: A Hematology Oncology Pharmacy Association Survey

Abstract

PURPOSE: Drug shortages are a clear and growing challenge. Prominent shortages included oncology medications and supportive care products essential for the care of patients with cancer. Oncology drug shortages often result in disruptions in the timing of chemotherapy treatments, alterations in the dose or regimen administered, or even missed doses when alternative agents are unavailable. The purpose of this survey was to characterize the impact of oncology drug shortages across the United States, including the experiences of health care organizations, resource implications, and the impact on patient safety, patient care, and clinical trials. METHODS: A 36-item online survey was distributed to membership of the Hematology/Oncology Pharmacy Association to gather information on shortages of oncology drugs (ie, all drugs essential in the care of patients with cancer, including supportive care agents). RESULTS: Sixty-eight US organizations participated in the survey between December 2019 and July 2020. Sixty-three percent of institutions reported one or more drug shortages per month, with a 34% increase in 2019 from 2018. Treatment delays, reduced doses, or alternative regimens were reported by 75% of respondents. The most difficult agents to obtain were vincristine, vinblastine, intravenous immunoglobulin, leucovorin, and Bacillus Calmette-Guerin. CONCLUSION: A survey of US oncology pharmacists indicated that oncology drug shortages occurred frequently in 2020. Shortages led to delays in chemotherapy and changes in treatment or omission, complicated clinical research, and increased risk of medication errors and adverse outcomes.

Experience of Pharmacists with Anti-Cancer Medicine Shortages in Pakistan: Results of a Qualitative Study

“…A study on the impact of COVID-19 on global drug shortages emphasized a similar aspect [ 25 ]. Studies in the US also highlighted the increase in medicine shortages during the pandemic [ 26 , 27 ].…”

“…In the case of proactive activities, even after well anticipation, financial constraints limit the procurement capacity, and only a few private setups or well-established NGO-based hospitals could be able to procure up to their need and for procuring more brands, only a few generics/brands are approved. For counteractive strategies, managing within hospitals leads to a change of protocol (rescheduled expensive treatment with or without compromised outcomes) [ 28 ], delayed treatment, and switching to alternatives (expensive second or third-line agents with less efficacy increased chances of medication error), all three would impact the optimum health outcomes to some extent [ 27 , 33 , 37 ].…”

Beyond fludarabine: pentostatin plus cyclophosphamide are a well-tolerated alternative in reduced intensity conditioning

“…The fludarabine shortage is causing unease within the hematopoietic cell transplantation (HCT) and cell therapy community as most reduced intensity (RIC) platforms along with conditioning for engineered T cell products rely on fludarabine for lymphodepletion. A recent national survey drew attention to the significant impact of oncology drug shortages causing treatment delays and rising hospital costs [1]. Due to manufacturing delays, access to fludarabine specifically has been disproportionately affected in 2022.…”

Post COVID availability of oncology drugs – Is this the new normal on both sides of the Atlantic?

“…As many anticancer drugs are only available as the generic version, the disruption within this supply chain has affected a substantial number of oncology patients worldwide. 8,9 This sector of the pharmaceutical industry relies heavily upon sourcing the main generic drug or active pharmaceutical ingredients from countries such as Asia, India and China. 2 Often termed as the 'production bottlenecks', any supply chain interruptions in these countries will have global consequences.…”

“…In the United States, there has been an increase in clinical risk associated with prescribing alternative cancer treatment as a result of drug shortages. 9 A national survey completed by hospital oncology and haematology pharmacists reported that the prescribing of alternative agents has led to medication near-misses and errors (16% and 6%, respectively). 9 In the United Kingdom, in July 2022, 54% of pharmacists responding to a survey carried out by The Pharmaceutical Journal said that medicine shortages were now putting patient safety at risk.…”