Nick Mulcahy

June 03, 2013

CHICAGO — More than 80% of cancer physicians reported experiencing cancer drug shortages over a 6-month period in 2012, according to a survey of 214 doctors conducted by researchers from the University of Pennsylvania in Philadelphia.

And the drug shortage situation is largely static, with the shortages only slightly improving from late 2012 to early 2013, according to a second survey sponsored by the American Society of Clinical Oncology (ASCO®).

The Penn survey will be presented here at the 2013 Annual Meeting of ASCO.

The Penn survey revealed that 174 of the 214 survey respondents said that they are making modifications to their patient care to accommodate the shortages.

"We were surprised that 83% of responding clinicians were unable to prescribe the preferred chemotherapy agent because of drug shortages," study coauthor Keerthi Gogineni, MD, from the Abramson Cancer Center at the University of Pennsylvania, told Medscape Medical News.

She was also surprised by the large number of cancer doctors who had to make changes in the way they care for patients.

Table. Drug-Shortage Workarounds Reported by Survey Respondents

Adaptation Number of Oncologists Reporting Modification, % (n = 173)
Switch regimens 79
Substitute drug partway through therapy 77
Delay treatment 43
Choose among patients 37
Omit doses 29
Reduce doses 20
Refer patients to another practice 17

 

Another option is to borrow drug from another facility or practice, said Otis Brawley, MD, chief medical officer of the American Cancer Society in Atlanta, Georgia.

"Sometimes, local hospitals will exchange or loan drugs," he told Medscape Medical News in an interview at the meeting. The interchange is facilitated by directors of pharmacy who know each other socially and professionally, Dr. Brawley explained.

Dr. Brawley is a practicing oncologist at Emory University Hospital and the public Grady Memorial Hospital, both in Atlanta. The 2 facilities share some ancillary services, including pharmacy, which sends out a weekly email every Monday morning to all clinicians on drug shortages. The email announces anticipated drug shortages, makes recommendations for a substitute, and emphasizes restrictions for the use of any existing stock. "They're very organized," Dr. Brawley said about the effort.

In the Penn survey, respondents said that the drugs most commonly in shortage are leucovorin (68%), liposomal doxorubicin (63%), 5-fluorouracil (19%), bleomycin (18%), and cytarabine (17%).

The shortages are solely the result of market forces, except for liposomal doxorubicin; a fire at a factory in Toledo, Ohio, resulted in environmental contamination that affected its production, he explained.

Cytarabine is part of the curative regimen for acute leukemias that affect adults and children. "I don't know of a substitute for cytarabine," said Dr. Brawley. "I don't know what clinicians are going to do without it."

The cancer drug shortage is likely to be ongoing and unrelenting; it is a "persistent issue," said Dr. Gogineni.

The respondents to the Penn survey also reported that shortages are driving up the cost of care because physicians are forced to substitute more expensive drugs for cheaper generics.

The survey showed that oncologists substitute more expensive branded drugs for those in short supply, such as levoleucovorin for leucovorin, 38% of the time.

Quality is also being negatively affected, and widely so, he said.

When asked about the impact of cancer drug shortages in the previous 6 months, 94% reported that their patients' treatment was affected, and 83% were unable to provide standard chemotherapy. About 13% of respondents reported that shortages prevented patient enrollment or suspended participation in clinical trials.

The Penn survey was distributed to 454 board-certified oncologists and hematologists in the United States who were randomly selected from the ASCO member directory. Of the 250 responses received, 214 were included in the analysis. Respondents were statistically evenly distributed in the Northeast, South, Midwest, and West regions of the country. About two thirds of respondents practiced in community-based private settings, and one third practiced in university-based academic settings.

ASCO Survey

The survey of ASCO members was conducted in October 2012 and in April 2013 to determine whether legislative and regulatory efforts to address shortages are working.

For the most part, it appears that they are not.

The surveys had 390 and 462 respondents, respectively.

The second survey suggests that chemotherapy drug shortages have eased very slightly, according to a meeting press release. However, the changes were small. Specifically, fewer of physicians surveyed were aware of ongoing drug shortages in the community in April and in October (59% vs 70%).

Moreover, respondents expressed growing concern about the shortage of nonchemotherapy drugs and supportive care that are critical for cancer patient care, such as antiemetics, pain medications, and basic intravenous fluids and electrolytes.

This research was supported in part by a Pfizer Medical. Dr. Gogineni reports research funding from Pfizer.

2013 Annual Meeting of the American Society of Clinical Oncology. Abstract CRA6510. To be presented June 4, 2013.

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