US cancer centers still see ‘widespread’ shortages of life-saving chemo drugs, survey finds

By Jacqueline Howard, CNN

(CNN) — Some of the nation’s largest cancer centers are reporting little improvement in an ongoing shortage of critical chemotherapy drugs in the United States.

Among 29 cancer centers across the country, 72% reported a shortage of the chemotherapy medication carboplatin, and 59% are still seeing a shortage of the drug cisplatin, according to survey results released Thursday by the National Comprehensive Cancer Network. Carboplatin and cisplatin are used in combination to treat many types of cancer.

Overall, the majority of surveyed centers – 86% – reported a shortage of at least one type of anti-cancer drug.

The survey, conducted from September 6 to 20 among 29 of the network’s 33 institutions, is an update to a survey conducted in May that found 93% of cancer centers reported a shortage of carboplatin and 70% reported similar shortages of cisplatin.

Cisplatin and other similar platinum-based drugs are prescribed for an estimated 10% to 20% of all cancer patients, according to the National Cancer Institute.

Several cancer medications have been in and out of shortage for years, and there have been record shortages this year, according to the American Association for Cancer Research. The White House said in September that the nation has a shortage of 15 cancer drugs due to manufacturing and supply chain issues. Three of those drugs – cisplatin, carboplatin and methotrexate – are widely used generics that have been staples of cancer treatment for decades.

“Everyone with cancer should have access to the best possible treatment according to the latest evidence and expert consensus guidelines,” Dr. Robert Carlson, CEO of the National Comprehensive Cancer Network, said in a news release.

“Drug shortages aren’t new, but the widespread impact makes this one particularly alarming. It is extremely concerning that this situation continues despite significant attention and effort over the past few months,” he said. “We need enduring solutions in order to safeguard people with cancer and address any disparities in care.”

Carboplatin and cisplatin are “core drugs” for treating cancer, and questions need to be answered about how to make sure shortfalls don’t happen again, said Dr. William Dahut, chief scientific officer for the American Cancer Society, who was not involved in the new survey.

“The manufacturing side is really the aspect that’s most important to get this right,” he said.

“Should there be some drugs in reserve? Should there be ability to look at supply chains or economic issues?” Dahut asked. “But who actually would enforce those? Who would pay for those? How would that work? I think that needs to be worked out. But I do think a short-term, medium-term and long-term philosophy is needed, as opposed to moving from crisis to crisis.”

The centers that took part in the new survey also said that several other key cancer medications are in short supply, with 66% reporting a shortage of the chemotherapy methotrexate, 55% a shortage of the chemotherapy 5-fluorouracil, 45% for the chemotherapy fludarabine and 41% for the corticosteroid medicine hydrocortisone.

Nearly all of the centers in the survey reported being able to treat every patient who needed carboplatin or cisplatin, despite a lowered supply, by implementing strict waste management strategies and other approaches.

“These drug shortages are the result of decades of systemic challenges,” Alyssa Schatz, the network’s senior director of policy and advocacy, said in the news release.

“We recognize that comprehensive solutions take time and we appreciate everyone who has put forth proposals to improve investment in generics and our data infrastructure,” Schatz said. “At the same time, we have to acknowledge that the cancer drug shortage has been ongoing for months, which is unacceptable for anyone impacted by cancer today. These new survey results remind us that we are still in an ongoing crisis and must respond with appropriate urgency.”

The cancer centers that were surveyed are leading academic centers and may not reflect any additional challenges that smaller practices may be experiencing, especially in rural areas or in communities that are under-resourced, according to the network.

The network is a not-for-profit alliance of cancer centers in the United States, including Fred Hutchinson Cancer Center, the Mayo Clinic Comprehensive Cancer Center, MD Anderson Cancer Center and the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins.

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