Cancer drug shortages mean higher costs and greater risk for patients

March 21, 2013

A national survey of health professionals showed that drug shortages are taking a heavy toll on cancer patients, forcing treatment changes and delays that for some patients meant worse outcomes, more therapy-related complications and higher costs. St. Jude Children's Research Hospital investigators played an important role in the study.

The survey queried oncology pharmacists and others involved in managing for , and other cancer treatment facilities nationwide. Of the 243 individuals who completed the survey, 98 percent reported having dealt with a shortage of at least one or other essential cancer-related drug in the previous 12 months. Ninety-three percent reported that shortages forced delays in chemotherapy administration or other changes in cancer drug therapy.

Researchers found the shortages also disrupted and added to the cost and risks associated with cancer treatment. One institution linked a patient's death to a shortage-related medication mistake. Overall, 16 percent of respondents tied shortages to adverse patient outcomes, including disease progression or more treatment-related complications.

The survey is the first to focus specifically on the impact of cancer-related drug shortages. It was conducted by the Hematology/Oncology Pharmacy Association and focused on a 12-month period ending in October 2011. The results appear in the April 1 edition of the American Journal of Health-System Pharmacy.

"This survey documents the risk that drug shortages pose to of all ages,"said the study's senior author, James Hoffman, Pharm.D., an associate member of the St. Jude Department of and the hospital's medication outcomes and safety officer. "To cure cancer we must often use complex , 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.

"Drug supplies remain unpredictable and serious problems persist," Hoffman said. In February, the University of Utah Drug Information Service was tracking national and regional shortages of more than 320 drugs, which is the highest number since 2010. The University of Utah Drug Information Service tracks drug shortages and provides advice about managing shortages through the American Society of Health-System Pharmacists.

The survey follows an earlier St. Jude-led study that linked a shortage of the chemotherapy drug mechlorethamine to a greater risk of relapse for some young Hodgkin lymphoma patients. Relapse meant those patients underwent additional intensive therapy that left them at greater risk for infertility and other treatment-related health problems later.

Multiple factors contribute to drug shortages, including manufacturing and quality problems, production delays and discontinuations. Earlier studies have shown that most shortages occur in the supply chain of generic injectable drugs, particularly medications to combat cancer and infections. In 2012, new federal 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. "While the FDA and others have worked diligently to address the problem, additional action is needed to address continuing shortages," Hoffman said.

The survey found shortages increase health care costs as scarcity drives up the price and requires staff time to manage the problem. About one-third of institutions in this 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. This 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.

In this survey, the drugs most frequently reported 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.

Explore further: Drug shortage linked to greater risk of relapse in young Hodgkin lymphoma patients

Related Stories

Drug shortage linked to greater risk of relapse in young Hodgkin lymphoma patients

December 26, 2012
A national drug shortage has been linked to a higher rate of relapse among children, teenagers and young adults with Hodgkin lymphoma enrolled in a national clinical trial, according to research led by St. Jude Children's ...

Anti-infective drug shortages pose threat to public health and patient care

January 20, 2012
Shortages of key drugs used to fight infections represent a public health emergency and can put patients at risk, according to a review published in Clinical Infectious Diseases and available online. Frequent anti-infective ...

FDA: New suppliers to ease 2 cancer drug shortages

February 21, 2012
Federal regulators said Tuesday that they've approved new suppliers for two crucial cancer drugs, easing critical shortages - at least for the time being - that have patients worried about missing life-saving treatments.

Fear in US as drug shortages mount

September 4, 2011
Shortages of vital drugs, particularly cancer-fighting medication, have raised concerns in the United States, where regulators often have to race to try to find replacements.

Hoping to ease shortage, FDA fast-tracks generic form of cancer drug

February 4, 2013
(HealthDay)—Seeking to ease potentially dangerous shortages of a key cancer drug, the U.S. Food and Drug Administration on Monday announced it had fast-tracked the approval of the first generic form of one such medication, ...

Canada needs national approach to protect against drug shortages

August 20, 2012
Canada needs a national approach to managing its supply of pharmaceutical drugs, starting with a mandatory reporting system for drug shortages, argues an editorial in CMAJ (Canadian Medical Association Journal) and CPJ (Canadian ...

Recommended for you

No dye: Cancer patients' gray hair darkened on immune drugs

July 21, 2017
Cancer patients' gray hair unexpectedly turned youthfully dark while taking novel drugs, and it has doctors scratching their heads.

Shooting the achilles heel of nervous system cancers

July 20, 2017
Virtually all cancer treatments used today also damage normal cells, causing the toxic side effects associated with cancer treatment. A cooperative research team led by researchers at Dartmouth's Norris Cotton Cancer Center ...

Molecular changes with age in normal breast tissue are linked to cancer-related changes

July 20, 2017
Several known factors are associated with a higher risk of breast cancer including increasing age, being overweight after menopause, alcohol intake, and family history. However, the underlying biologic mechanisms through ...

Immune-cell numbers predict response to combination immunotherapy in melanoma

July 20, 2017
Whether a melanoma patient will better respond to a single immunotherapy drug or two in combination depends on the abundance of certain white blood cells within their tumors, according to a new study conducted by UC San Francisco ...

Discovery could lead to better results for patients undergoing radiation

July 19, 2017
More than half of cancer patients undergo radiotherapy, in which high doses of radiation are aimed at diseased tissue to kill cancer cells. But due to a phenomenon known as radiation-induced bystander effect (RIBE), in which ...

Definitive genomic study reveals alterations driving most medulloblastoma brain tumors

July 19, 2017
The most comprehensive analysis yet of medulloblastoma has identified genomic changes responsible for more than 75 percent of the brain tumors, including two new suspected cancer genes that were found exclusively in the least ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.