Widespread shortages of cancer drugs are forcing doctors to make difficult decisions about treating their patients, including rationing doses and using other treatment options with potentially greater side effects.
As of Wednesday, the Food and Drug Administration listed 14 cancer drugs with shortages.
“The shortage of oncology is particularly critical,” said FDA Commissioner Dr. Robert Califf to NBC News. “I’m a former intensive care doctor and I’m very aware of the consequences of not getting the chemotherapy you need.”
Drug shortages hit record high, according to a March report by the Senate Committee on Homeland Security and Governmental Affairs. The shortage of new medicines increased by almost 30% between 2021 and 2022. By the end of 2022, there were 295 active drug shortages, a record five years.
“I know of no worse time than this,” said Dr. Julie Gralow, chief medical officer and vice president of the American Society of Clinical Oncology. “What’s special about this shortage, I think, is just the broad applicability of these drugs, how important they are, you know, worldwide, in the US, in the treatment of many diseases.”
Deficiency drugs include carboplatin, a chemotherapy drug used as a first-line treatment for a number of cancers.
“Carboplatin is such an important drug in the treatment of many types of cancer – including breast cancer, ovarian cancer, head and neck cancer, lung cancer,” said Dr. Lucio Gordan, medical oncologist and President of the Florida Cancer Specialists and Research Institute. a network of cancer clinics. Gordan said they had been off any medication for almost two weeks.
“I’ve been doing this for over 20 years. It’s the worst thing I’ve ever seen,” he said.
Florida Cancer Specialists knew the shortage was coming and were trying to prepare for it. In the past few months, they’ve been rationing by rounding down carboplatin doses by 10%, which Gordan says doesn’t affect the drug’s effectiveness.
“We’ve been rounding off for a while,” he said. “But we just ran out of meds, so there’s nothing to argue about.”
Carrie Cherkinsky, 41, of Tallahassee, Fla., learned about the shortage through a Facebook support group for women with ovarian cancer. Still, she was shocked to learn she couldn’t get her second round of chemotherapy, scheduled for May 15, at Florida Cancer Specialists. Gordon was not involved in her care.
“Who will be held accountable for this?” said Cherkinsky, who was diagnosed with ovarian cancer in March. “Not getting life-saving treatment?”
Carboplatin is not only an effective drug; It is also less toxic and causes fewer side effects than other drugs available.
“However, one of the problems with these alternative drugs is that they often aren’t as good and therefore can affect survival outcomes,” said Dr. Angeles Alvarez Secord, President of the Society of Gynecologic Oncology.
Furthermore, “The more toxicity there is, the more expensive it is to treat because you’re also dealing with the side effects or you’re giving additional medication to try to prevent the side effects,” Secord said. “Although there are alternatives, they often still do not meet the best standard of care.”
Hospitals and cancer centers nationwide are being forced to make similar decisions when treating cancer.
Doctors in at least 40 states have shortages of at least one chemotherapy drug, according to a survey conducted in May by the Society of Gynecologic Oncology.
More drug shortage news
dr Eleonora Teplinsky, a breast and gynecological medical oncologist at Valley Health System in New Jersey, said the shortages are devastating.
“Cancer is life-changing anyway, but as a patient you expect to walk into a doctor’s office and get the best there is,” Teplinsky said. “And right now, for certain types of cancer, we don’t have the very best we can do.”
Drug shortages not only mean additional stress for cancer patients, but also for medical service providers. Not only are physicians working in a workforce already burned out and exhausted by the pandemic, but they are still scrambling to find life-saving treatments.
“All practices in the country, not just oncology, we’ve been under a lot more stress since Covid,” Gordan said. “This is another disadvantage that prevents us from doing our best.”
Bottlenecks can sometimes surprise providers.
Suppliers do not warn when a drug shortage is imminent; They’ll just stop filling all of their orders, said Andrea Iannucci, assistant chief pharmacist at UC Davis Health. “So we place an order and think it’s going to arrive, but that doesn’t happen because the drug wasn’t available,” Iannucci said.
Keri Carvill, 44, of Sacramento, California, was diagnosed with triple-negative breast cancer in March but was unable to receive her first dose of carboplatin until May 19. Triple negative breast cancer is a particularly aggressive form of the disease.
“It’s stressful and scary,” Carvill said.
What caused the deficiency and what can fix it?
The current shortage of carboplatin was caused in part by quality concerns at a manufacturing facility, Intas Pharmaceuticals, in India, but experts say the real problem is more chronic.
“Unfortunately, the profitability of this industry is very low or non-existent,” Califf said. “A number of companies either go out of business or face quality problems because of difficulties investing in their technology. That is the main reason for the shortage that we are seeing.”
In a statement to NBC News, Intas Pharmaceuticals said it is working with the FDA to clear existing stocks of carboplatin and other medically necessary products. It’s also working with the agency on a plan to resume production, but added that a date for that hasn’t been confirmed yet.
Califf said the FDA is working with other manufacturers to make more carboplatin available.
However, long-term solutions require “action by Congress and the White House to put this industry in the right place,” he said, adding that a White House team has been working on the drug shortage issue.
Teplinsky, the New Jersey oncologist, said she encouraged her social media followers to reach out to elected officials to advocate for timely production of chemotherapy drugs and long-term guidelines to ensure something like this doesn’t happen again happens.
“Delaying care impacts outcomes,” Teplinsky said. “And in that case, we either can’t give people what they need, or we have to wait, which we know will have negative consequences.”Follow NBC HEALTH At Twitter & Facebook.