Cancer drug shortage forces doctors to make some tough decisions

A nationwide shortage of more than a dozen chemotherapy drugs, including several preferred ones used to treat gynecological and other cancers, has forced Wichita providers into difficult conversations about how to treat cancer patients.

The shortage sometimes means prioritizing which patients qualify for the preferred frontline therapy and which can be managed using alternative drug therapies.

“We’re consciously having to conserve these drugs for primary treatments, curative treatments,” said Jacqueline Morgan, MD, a gynecologic oncologist with Associates in Women’s Health. “Pediatric patients are getting the first access to drugs, and now patients on second- or third-line treatments may be jumping over these drugs to the next options.”

A U.S. Senate Committee report released in March on the health and security risks of drug shortages noted that shortages of critical medications continue to rise, increasing by nearly 30% between 2021 and 2022. Shortages are blamed on several factors, including economic drivers, insufficient supply chain visibility, and a continued U.S. overreliance on both foreign and geographically concentrated sources for medications and their raw materials, the report said.

“These shortages have cascading effects on patient care, causing delays in treatment, increasing the risk of medication errors, and requiring the use of less effective alternative treatments,” the Senate committee wrote.

Hospitals have been hardest hit by this drug shortage, housing comparatively limited quantities of in-demand chemotherapy drugs as compared with outpatient centers focused solely on treating cancer patients, providers said.

“It has definitely put us in an unexpected area where we were needing to say to ourselves, do we have to restrict the use of these agents to only patients with a curative track vs. those who are just using it to manage symptoms?” said Derick Gross, an adult oncology pharmacist with Wesley Medical Center. “Fortunately, we haven’t got into a situation where we’ve had newly diagnosed people needing chemo for a cure and we couldn’t give it to them. We’ve been able to navigate it.”

There are signs the drug supply shortage may be easing a little. Earlier this month, FDA Commissioner Robert Califf, MD, announced the U.S. had taken steps to import certain foreign-approved versions of chemo drug cisplatin from FDA-registered facilities, referring to a deal struck with China-based Qilu Pharmaceutical. Califf also said the FDA is using “regulatory discretion” for continued supply of other platinum analogues to help meet patient needs.

“Thankfully, the shortages seem to be improving,” said Joseph Moore, MD, a medical oncologist with the Cancer Center of Kansas.

“Some of the hospitals in town have gotten some supplies, so they are relaxing restrictions. We are actively acquiring the drugs,” he said. “Hopefully the supplies will continue improving and we’ll be able to get chemotherapy to everyone who needs it.”

Physicians in Wichita have been admirably navigating the crisis by working well with one another, the hospitals and the outpatient cancer treatment centers, Morgan said. But, even so, rationing therapy drugs is not a position any oncologist wants to be in.

“It’s just another layer of complexity to deal with when trying to make the right decision for our patients,” Morgan said.