As cancer drug shortages grow, some doctors are forced to ration doses or delay treatment.

The widespread shortage of cancer drugs is forcing doctors to make difficult decisions about how to treat their patients, including rationing doses and turning to other treatment options with potentially more side effects.

On Wednesday, the Food and Drug Administration listed 14 missing cancer drugs.

“The oncology shortage is especially critical,” said FDA Commissioner Dr. Robert Califf, to NBC News. “I am a former critical care physician and am very aware of the consequences if you don’t get the chemotherapy you need.”

Carrie Cherkinsky. caption: Carrie Cherkinsky, right, was traveling in Australia in March when she started experiencing severe abdominal pain. Doctors discovered a mass on her right ovary. (Courtesy Carrie Cherkinsky)

According to a March report by the Senate Committee on Homeland Security and Governmental Affairs, drug shortages are at record levels. New drug shortages increased by nearly 30% between 2021 and 2022. At the end of 2022, there was a five-year record shortage of 295 active drugs.

“I don’t know of a worse time than this,” said Dr. Julie Gralow, chief medical officer and executive vice president of the American Society of Clinical Oncology. “I think what’s different about this shortage is just the broad applicability of these drugs, how important they are, you know, globally, in the US, in treating many diseases.”

Among the missing drugs is carboplatin, a chemotherapeutic agent used as a first-line treatment for several types of cancer.

“Carboplatin is a very important drug for the treatment of many types of cancer – breast, ovarian, head and neck cancer, lung cancer, among many others,” said Dr. Lucio Gordan, medical oncologist and president of the Florida Cancer Specialists and Research Institute, a network of cancer clinics. Gòrdan said they were completely drug free for almost two weeks.

“I’ve been doing this for over 20 years. This is the worst I’ve ever seen,” he said.

Florida cancer specialists knew the shortage was coming and tried to prepare. For the past two months, they’ve rationed by rounding down carboplatin doses by 10%, which Gòrdan said didn’t lessen the drug’s effectiveness.

“We’ve been rounding down for a while now,” he said. “But we’re done with drugs, so there’s nothing to work around.”

Shortage of cancer drugs.  (NBC News)

Shortage of cancer drugs. (NBC News)

Carrie Cherkinsky, 41, of Tallahassee, Florida, learned of the shortage of a Facebook support group for women with ovarian cancer. Even so, she was shocked to learn that she would not be able to have her second round of chemotherapy, scheduled for May 15 at Florida Cancer Specialists. Gòrdan wasn’t involved with her care.

“Who will be held accountable for this?” said Cherkinsky, who was diagnosed with ovarian cancer in March. “Because I didn’t get life-saving treatment?”

Carboplatin is not just an effective drug; it is also less toxic and causes fewer side effects than other available drugs.

“One of the problems with these alternative medicines is that they are often not as good, so they can compromise survival outcomes,” said Dr. Angeles Alvarez Secord, president of the Society of Gynecologic Oncology.

Also, “when there’s more toxicity, there’s more cost for treatment because you’re also dealing with side effects or giving additional medications to try to prevent side effects,” Secord said. “Therefore, alternatives often, even if they are present, still do not meet the best standard of care.”

Across the country, hospitals and cancer centers have been forced to make similar decisions when it comes to cancer care.

According to a survey conducted in May by the Society of Gynecologic Oncology, physicians in at least 40 states are missing at least one chemotherapy drug.

Dr. Eleonora Teplinsky, a breast and gynecologic oncologist at Valley Health System in New Jersey, said the shortage is devastating.

“Cancer is life changing, but you expect, as a patient, to walk into an office and be given the best there is,” Teplinsky said. “And now we don’t have the best to give in certain cancers.”

Drug shortages cause extra stress not only for cancer patients but also for healthcare professionals. In addition to being in a workforce that is already burned out and exhausted from a pandemic, physicians must scramble to find life-saving treatments.

“All practices in the country, not just oncology, have been much more stressed since Covid,” Gordan said. “This is another curveball that keeps us from doing the best we can.”

Sometimes shortages can catch providers off guard.

Suppliers don’t tell you when a drug is about to run out; they’ll just stop filling all your orders, said Andrea Iannucci, assistant chief pharmacist at UC Davis Health. “So, we place an order and we think it will arrive and it doesn’t, because the medicine was not available,” said Iannucci.

Keri Carvill, 44, of Sacramento, Calif., 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 led to the shortage and what can you fix?

The current carboplatin shortage has been caused in part by quality concerns at one factory, 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. “Several companies are closing their doors or facing quality problems due to the difficulty of investing in their technology. That is the main underlying reason for the shortages we are seeing.”

In a statement to NBC News, Intas Pharmaceuticals said it is working with the FDA to clear existing stock of carboplatin and other medically necessary products. It is also working with the agency on a plan to resume manufacturing, but added that a date for that to happen has yet to be confirmed.

Califf said the FDA is working with additional manufacturers to make more carboplatin available.

Long-term solutions, however, will require “intervention by Congress and the White House to get this industry in the right place,” he said, adding that a White House team is working on the issue of drug shortages.

Teplinsky, the New Jersey oncologist, said she is encouraging her social media followers to reach out to elected officials to advocate for timely production of chemotherapy drugs and long-term policies to ensure this doesn’t happen again.

“Delaying care affects outcomes,” Teplinsky said. “And in that case, either we can’t give people what they need or we have to wait, which we know will lead to negative consequences.”follow NBC HEALTH about twitter & Facebook.

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As cancer drug shortages grow, some doctors are forced to ration doses or delay treatment.

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