Cancer Drug Shortages

Dr. Ezekiel Emanuel, oncologist and former presidential adviser, raised the level of discussion of cancer drug shortages with the August 2011 publication of his opinion piece, Shortchanging Cancer Patients, in the New York Times. Leaving aside his opinions and proposed solution, the key fact is that there are shortages of inexpensive drugs that are known to cure cancer.

These shortages are ongoing and serious. As of January 13, 2012, the latest is Shortage of injectable vinblastine. This drug is used in at least three chemotherapy regimens for Hodgkin's lymphoma (ABVD, ChlVPP/EVA, Stanford V), for metastatic breast cancer (MVP), and for advanced bladder cancer (MVAC). Since there is no direct substitute for vinblastine, this shortage leaves patients waiting for treatment, doctors and hospital pharmacies scrambling to accumulate enough of the drug for a round of therapy without resorting to gray-market suppliers, doctors and patients considering less familiar therapies whose outcomes are also less well known, doctors and bioethicists making decisions about who will receive treatment, and patients with decisions about how they will pay for treatment. All these and more are reflected in the ASHP flowchart in my post.

In 2006 National Analysts Worldwide began an oncology market surveillance program, with the latest market survey of oncologists completed in January 2012. CEO and researcher Susan Schwartz McDonald summarizes the survey as follows: “At a time when important advances promise new hope in many forms of cancer, chronic drug shortages and reduced access to care threaten to undermine our ability to combat disease.” The quote and highlights of the survey may be found in Enhanced Online News.

"Drug Shortages Have Hastened Cancer Deaths

• Nearly half of U.S. oncologists saw grave health consequences due to drug shortages: 48 percent report seeing tumor recurrence and 40 percent have seen patients die sooner.
• In the past year, nearly all U.S. oncologists (95 percent) have had patients in their practice who were unable to receive timely treatment due to drug shortages, and over 85 percent have had patients who were unable to receive the best treatment altogether.
• This trend is projected to continue in the coming year: half of oncologists (50 percent) expect to see hastened cancer deaths occurring more often, whereas few (14 percent) anticipate a reversal of the trend.

Drug Costs Are Resulting in Suboptimal Care for Some Patients

• Nearly eight in 10 U.S. oncologists (79 percent) have treated patients with what they believe is suboptimal therapy due to lack of health insurance.
• Almost as many (73 percent) have treated insured patients with something short of the most effective therapy due to patient inability to afford drug co-payments.

Optimism about the State of Science is Offset by Pessimism about Affordability of Access

• Over 80 percent of oncologists express optimism about new discoveries in the biology of cancer and tailored anti-tumor therapies, as well as the potential for new treatments to improve survival and quality of life.
• At the same time, 70 percent are pessimistic that new treatments will be affordable for patients or society."

In the latest National Analysts Worldwide blog post, Debbie Kossman stated that the survey results will be discussed in greater detail in further weeks, with projections for physicians and patients.