Americans are Largely Unaware of Cancer Drug Shortages and Drug Substitutions

Chemotherapy - Medical Concept. On Background of Medicaments Composition - Red Pills, Injections and Syringe.

The American population is,  according to a study published online in CANCER, a peer-reviewed journal of the American Cancer Society, is largely unaware that there are shortages in the availability of cancer drugs,

The survey results show tat most people participating in the study said that if they were patients, they would want to know about the availability of a substitute therapy that would be given due to a shortage.  They also said that they would transfer care to avoid a substitution with major differences from the preferred therapy

Impairing patient care
Drug shortages can impair patient care, raise healthcare costs, and hamper clinical trials. Regarding cancer drug shortages, studies have investigated the experiences and opinions of oncologists or examined the economic impact of shortages, but there are sparse data regarding how patients might approach any drug shortages.

To investigate, a team led by Gregory Abel, MD, MPH, and Zachary Frosch, MD, of Dana-Farber Cancer Institute and Brigham and Women’s Hospital, in Boston, administered a 13-item survey to 420 respondents randomly selected from an online sample demographically representative of the adult United States population with respect to gender, age, race-ethnicity, education, geography, and income.

Study results
Overall, 16% of respondents reported being aware of drug shortages, and respondents with a personal history of cancer were more likely to be aware (31% versus 14%). Most survey respondents reported that if they were patients, they would want to be informed about a substitution due to a shortage: 87% and 82% for major or minor differences in efficacy, and 87% and 83% for major or minor differences in side effects.

Most study participants also reported that they would transfer care to avoid a substitution with major differences from the preferred therapy: 72% for major differences in efficacy, and 61% for major differences in side effects. Black respondents, the uninsured, the unemployed, those with lower income, and the less well-educated were all less likely to report that they would transfer care to avoid major differences in efficacy.

Not a good idea
Shortages in the availability of  cancer drugs may lead to delay in treatment, which is never a good solution. In addition, the available substitutions may be less effective, while in some cases there is no effective work-around available.Drug shortages may also increase time and expense of finding drug supply, have an adverse effect on ongoing clinical trials and increase the overall cost of care. But most worrisome, physicians have noted increased patient anxiety as a result of drug shortages.

“It can be stressful for patients with cancer to learn that their care may be impacted by drug shortages, but it’s important for oncologists to engage patients in these discussions,” Frosch said.

“Our data suggest that people expect disclosure of shortages as part of the caregiving process,” he added.

Frosch also noted that awareness of shortages—by patients and the public at large—may result in increased pressure to address the system-wide shortcomings that lead to shortages.

“It’s important that everyone—clinicians, patients, and the public—have a seat at the table as these strategies are developed,” he concluded.

More information
A number of organizations and agencies offer up-to-date information about drug shortages. The U.S. Food and Drug Administration (FDA) maintains a list of drugs in shortage with information on expected duration of shortage and alternative suppliers. A different list of drugs in shortage is maintained by the American Society of Health-System Pharmacists (ASHP). While this information also  includes details about the expected duration of shortage and alternative suppliers, the list differs from the FDA list. The ASHP lists every drug shortage reported through their online report form as soon as it is investigated and confirmed – usually within 24-72 hours  – whereas the FDA focuses only on shortages of medically necessary drugs with the potential to impact public health.


Last Editorial Review: April 9, 2018

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