What to Know About the Cancer Drug Shortage and Questions to Ask Your Doctor
- As attention focuses on cancer drug shortages, SurvivorNet found variation when it comes to supply for some mainstay drugs, namely platinum-based chemotherapy drugs like cisplatin, carboplatin, and oxaliplatin.
- These drugs are widely used in treating many types of cancer, including breast, lung, ovarian, bladder and testicular cancers.
- Drug supply is impacting hospitals differently, but the major cancer centers we spoke to say they are monitoring their drug supply closely, assessing patient needs and implementing dose rationing if necessary.
- There is still clarity needed on the reason for the shortage, but business incentives and manufacturing supply chain issues are two areas that nay be contributing.
- Cancer patients and their loved ones should push for answers from their doctors about the availability of their current medication and ask what other options may be available to them if their drug is in short supply.
While national attention has increasingly focused on shortages of cancer drugs, SurvivorNet has found that significant variation exists when it comes to supply for some mainstay drugs, namely platinum-based chemotherapy drugs like cisplatin, carboplatin, and oxaliplatin. They are widely used in treating many types of cancer, including breast, lung, ovarian, bladder and testicular cancers.
While the reporting is still evolving on the scope of the drug shortage, the major cancer centers we've contacted say their patients are still able to get the chemotherapy drugs they desperately need. The cancer centers also tell us the rationing procedures they put in place have subsided for now.
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Alison Smith is the assistant director of pharmacy at the University of Kansas Cancer Center. She tells SurvivorNet the drug shortages are impacting cancer patients in the Kansas City area, but doctors have been able to implement methods to make sure patients are getting the critical care they need.
"In early 2023, the U.S. Food and Drug Administration (FDA) first announced a shortage of two similar chemotherapy drugs: cisplatin and carboplatin,” she said.
University of Kansas Cancer Center oncologists have been able to maintain a supply of cisplatin and carboplatin in part by adopting rationing recommendations from The Society of Gynecologic Oncology (SGO).
"Our health system oncologists are following that strategy and have determined appropriate shortage mitigation strategies in each disease state. This has included using alternative therapies when available and making sure patients receive the medications that best treat their conditions," Smith added.
The impact of the drug shortage is not the same across the country. A spokesperson for MD Anderson Cancer Center tells SurvivorNet they are not experiencing shortages of Carboplatin at this time. However, the spokesperson added they are “monitoring the situation” and developing plans and treatment alternatives if the situation changes.
Dr. Rebecca Arend from the University of Alabama Birmingham O’Neal Comprehensive Cancer Center tells SurvivorNet that their drug supply is sufficient.
Dr. Bobbie Rimel is a gynecologic oncologist at Cedars-Sinai Samuel Oschin Cancer Center in Los Angeles. She told SurvivorNet that her cancer center has been "fortunate so far" but added they have "moved to some dose reductions and careful planning to improve the amount of drug we do have."
Dr. Rimel went on to say oncologists have been trying to offer treatment "where drugs exist.” However, she admits that is not always easy to do.
That could be because patients may need to travel to other locations to receive their therapy, which they may not have the means or time to do. And they may face issues with insurance coverage when switching to a different treatment.
Another major area that could experience a significant impact is clinical trials. In these experimental trials patients receive a determined course of action to help determine the effectiveness of a drug or treatment. Problems arise when a patient is expected to use a drug in short supply. In these cases, completing the trial becomes challenging for both patients and researchers locked into a specific protocol that may or may not be available.
It’s also important to note that most cancer patients are treated at community hospitals and not major cancer centers like the ones SurvivorNet spoke to.
"Community hospitals treat approximately 80 to 85% of all cancer patients in the U.S." according to research published in the Annals of Oncology.
Many of these community medical practices are effective and have increased in scale due to recent consolidations. However, given how distributed these practices are, SurvivorNet and others are still working to understand what, if any, shortages are affecting patients at these facilities.
Dr. Emese Zsiros, chair of the Department of Gynecology Oncology at Roswell Park Comprehensive Cancer Center in Buffalo, New York, also said her center has an adequate supply of platinum-based therapies. But she added that they have seen people from the local community come to them to seek treatment due to shortages elsewhere.
“We’re not oblivious to the challenges associated with shortages,” Zsiros said.
Guidance for Patients
Cancer warriors and their loved ones helping them along their journeys may be wondering what to do if the cancer drug they need is not available. SurvivorNet spoke with experts like social workers and patient navigators, and consulted national organizations like City of Hope and CareCare, to provide some recommendations that can help people find solutions.
- Push for answers. Bring care partner with you to your appointments to help you listen, take notes, and process the information being given to you. Don't rest until you are satisfied with your care and the decision-making process.
- Evaluate other options. In most cases, there are other options for treatment. According to physicians who spoke to SurvivorNet, evaluating potential alternatives when the specific drug you are used to is not available is a conversation that should be had with your care team.
- Consider traveling. While traveling to a different area to get the cancer drug you need is not always feasible, it should be considered. Try calling around to various pharmacies and hospitals to determine treatment availability.
- Seek out a patient navigator. Knowing the right questions to ask or who to contact can be a daunting task, but patient navigators are there to help. They provide personalized support for patients.
- Connect with an oncology social worker. Like patient navigators, oncology social workers are there to help you get answers to questions and provide emotional support. Oncology social workers are licensed professionals trained to help people affected by cancer.
Help With Navigating Cancer Treatment
Why Are Shortages Happening Now?
There is still a lot of clarity needed to fully understand why certain drugs are in short supply right now.
There is speculation that drug makers producing older chemotherapy medications have little incentive to maintain large-scale production because these drugs are no longer protected by patents and have become less profitable.
Other reporting points to supply-chain issues from countries like China and India disrupting the flow of ingredients needed to produce the drugs. However, this reporting is unclear and questions remain.
Physicians who spoke to SurvivorNet admit they are not business people, but there is some discussion already that a larger government or FDA solution may be necessary to ensure the supply of key medications is maintained.
â€¼ï¸ Want to take action on #drugshortages? Reporting drug shortages or rationing in your facility to @US_FDA helps the agency understand the severity of supply problems and where immediate action is required. Report now: https://t.co/JYqHrAipmm
ASCO (@ASCO) May 16, 2023
The FDA already tracks drug shortages and maintains regular contact with drug manufacturers about supply levels. The agency says, "Drug shortages can occur for many reasons, including manufacturing and quality problems, delays, and discontinuations."
There may be one disruption reportedly involving Intas Pharmaceuticals based in India. The drug manufacturer produces chemotherapy drugs including cisplatin and carboplatin. The FDA found Intas Pharmaceuticals "lacked adequate oversight" during a November 2022 inspection, among other reported quality control violations.
The federal agency also reported that Intas Pharmaceuticals "failed to establish adequate written procedures for production and process controls designed to assure that the drug products have the identity, strength, purity, and quality that they are purported or represented to possess."
The company ended up suspending manufacturing U.S.-bound drugs while it addressed its quality control issues, according to The New York Times.
Other drug companies relying on the drug manufacturers were also impacted by disruptions. A spokesperson from Pfizer, a maker of carboplatin, told SurvivorNet that the company is dealing with the disruptions.
"Due to supply disruptions faced by external manufacturers, there continues to be shortages of carboplatin injection. To help with these supply constraints, Pfizer continues to explore options to release more product to ensure as best as possible that patients continue to have this treatment option available," Pfizer said in an emailed statement.
Fresenius Kabi also produces carboplatin and says it has been impacted by external manufacturers too. A spokesperson for the company told SurvivorNet that once Fresenius was notified by the FDA of the impending shortage in February, it ramped up its own production to help compensate.
"We have prioritized production of it [carboplatin]. However, it will take several weeks to ramp up the production," Matthew Kuhn said.
Kuhn went on to say Fresenius' increased production of carboplatin should be available in early June.
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All Shortages Are Not the Same
For patients who are trying to get new or exciting therapies such as CAR T-cell therapy for multiple myeloma, or radiation ligand therapy for prostate cancer, the issues around access and availability can vary dramatically.
These new drugs are still protected by patents, making them very attractive for the companies that have invested in their development. However, in many cases involving these newer drugs, ramping up production and supply presents differently when compared to much older drugs produced by an entirely different type of pharmaceutical manufacturer.
Questions for Your Doctor
If you have been faced with not being able to get your usual chemotherapy treatment – or are worried this could happen to you – here are some questions you may consider asking your doctor to get the conversation started:
- What does supply look like for the drug I’m taking? Is there enough to go around?
- What other treatment options exist for me in case my cancer medication is in short supply?
- Will these other options be as effective to help treat my cancer?
- If I need to travel farther away for my cancer medication, who can I call to help with travel arrangements?
- If I'm worried about managing the costs of cancer care, who can help me?
- What support services are available to me? To my family?
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