First, their shipments of carboplatin typically used to treat breast, ovarian and many other cancers have been delayed. They were able to switch some patients to cisplatin, another platinum-based drug that is just as effective but may have more side effects.
Hence, their cisplatin shipments stopped arriving on time.
To hold dwindling supplies longer, doctors have begun rounding patient doses up to 10 percent within professional guidelines and have begun preparing for the need to take more drastic action if shortages persist.
It’s part of a nationwide shortage of more than a dozen essential cancer drugs that has forced Kansas health care workers to ration drugs and consider delaying some treatments altogether.
I’m losing sleep over this, AdventHealth cancer pharmacist Kyla Bidne said. This deficiency is the worst that I can remember and I have been practicing it for about 20 years now.
At one point, supplies got so low that his team planned to move some patients to a completely different class of drugs only to walk in that morning and find a surprise shipment of the drug they needed.
We don’t really know from day to day when we’re going to get drugs or if we’re going to get drugs, Bidne said. We have to plan for the worst and hope for the best.
The US drug shortage is getting worse
The United States has long been susceptible to drug shortages, but they are becoming more frequent and lasting longer. The new drug shortage increased by almost 30% between 2021 and 2022 according to aUnited States Senate Committee Reportwho described the matter as a national security risk.
Drug supply chains offer little transparency about what is driving a particular shortage or how long it might last. This, in turn, makes it more difficult for government officials to respond.
The causes range from supply chain disruptions to quality issues, over-reliance on foreign manufacturers, export restrictions in source countries and fluctuations in demand. The pandemic has exacerbated existing supply chain vulnerabilities, triggering global shortages.
The shortage of anticancer drugs is particularly problematic
The shortage of cancer drugs, which has jeopardized the treatment of a wide range of adult and pediatric patients, is particularly problematic because getting prompt treatment can mean the difference between life and death.
In some cases, there isn’t a good alternative drug that is as effective, said Dr. Lisa Holle, a clinical professor at the University of Connecticut School of Pharmacy. So it can be extremely harmful and potentially life threatening.
Testicular cancer, for example, is usually treatable even when caught in advanced stages with cisplatin. Not being able to access the drug, he said, could put a cure out of reach for some patients.
Kansas doctors fear they may soon have to make agonizing choices about which patients to prioritize treatment.
This is a terrible decision, said Dr. Verda Hicks, president of the American College of Obstetricians and Gynecologists and a Leawood obstetrician-oncologist. It’s very difficult to value someone’s life.
The federal government is taking steps to address the crisis
Small hospitals often feel the pressure first because larger cancer centers usually have more reserve inventory to rely on and have more purchasing power when purchasing a limited amount of drugs from wholesalers.
It’s hard to predict when an institution or a patient will be affected, Holle said. Every day the situation changes due to a multitude of factors.
Last week, the U.S. Food and Drug Administration announced efforts to mitigate the shortage, including working with a currently unapproved Chinese pharmaceutical company to temporarily import more cisplatin. The agency also indicated it was exploring options for importing more carboplatin.
But it’s unclear how immediate the relief will be and how many patients will be affected before the problems are resolved.
Everyone is very concerned about this, Holle said. It is unclear what kinds of legislative changes could make these shortcomings disappear in the long run. But we need to start thinking about how we can handle this kind of thing.
Rose Conlon reports on health for KMUW and the Kansas News Service.
The Kansas News Service is a collaboration of KCUR, KMUW, Kansas Public Radio and High Plains Public Radio focused on health, the social determinants of health and their connection to public policy.
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