Penn Survey Finds Cancer Drug Shortages Affect Treatment, Research

Ongoing shortages of common oncology chemotherapies have compelled physicians to substitute more expensive drugs, delay or suspend clinical trials, or even skip doses of chemotherapy, according to survey results gathered by a team from the University of Pennsylvania.

The survey, led by Zeke Emanuel and Katie Shuman, represented a joint effort by Penn’s Perelman School of Medicine and the Wharton School of Business to reach 455 board-certified US oncologists selected from the membership of the American Society of Clinical Oncologists (ASCO), to assess drug shortages and how they affect decision-making.

Results of the survey, taken between September 20, 2012, and January 20, 2013, were released today at the 49^th Annual Meeting of ASCO in Chicago.

The Penn survey, which was self-administered, received 245 responses, for a rate of 55%. Of these, 210 respondents were practicing medical oncologists or hematologists.

Respondents reported overwhelmingly that drug shortages had affected their practice within the previous six months. Ninety-two percent (163) of the oncologists reported that patient treatment was affected and that 83% (174) were unable to prescribe standard chemotherapy.

Yet physicians were just as likely to have received little or no guidance on what to do when confronted with drug shortages; 70% (146) of oncologists said their cancer centers or practices lacked formal policies for how to allocate scarce drugs.

The 5 agents most likely to be in short supply were: leucovorin (68%), liposomal doxorubicin (63%), 5-FU (19%), bleomycin (18%), and cytarabine (17%).

At times, physicians substituted more expensive, branded drugs for those unavailable. This was reported 38% of the time. Shortages prevented enrollment of a patient in a clinical trial or delayed administration of a study drug 13% of the time.

Results of oncologists responding to the Penn survey reporting modifications due to drug shortages were as follows (n = 173): switch regimens, 79%; substitute drug during therapy, 77%; delay treatment, 43%; choose among patients, 37%; omit doses, 29%; reduce doses, 20%; refer patients to another practice, 17%.

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Emanuel Z, Shuman K, Chinn D, Gogineni K. Impact of onocology drug shortages. J Clin Oncol. 2013;(suppl; abstr CRA6510).