Eighty-three percent of cancer doctors report that theyâ€™ve faced oncology drug shortages, and of those, nearly all say that their patientsâ€™ treatment has been impacted, according to a study from researchers at the Abramson Cancer Center and the Perelman School of Medicine at the University of Pennsylvania that will be presented today at the 2013 annual meeting of the American Society of Clinical Oncology (Abstract #CRA6510). The results showed that shortages â€“ which have hit especially hard among drugs to treat pediatric, gastrointestinal and blood cancers â€“ have left physicians surveyed unable to prescribe standard chemotherapies for a range of cancers.
In the largest study of oncologists to quantify the toll of the cancer drug shortage to date, the research team surveyed a random sample of 500 board-certified U.S. oncologists in late 2012 and early 2013 to obtain information about the impact of drug shortages on their practice during the previous six months. Their findings, drawn from the 250 physicians who responded to the survey, will be presented by the studyâ€™s senior author Keerthi Gogineni, MD, MSHP, an instructor in the division of Hematology-Oncology in Pennâ€™s Abramson Cancer Center, during a press conference on Monday, June 3, 2013.
â€śOur results indicate that the vast majority of oncologists in the country are facing wrenching decisions about how to allocate lifesaving drugs when there arenâ€™t enough to go around,â€ť Gogineni says. â€śThe potential impact of these drug shortages is vast: theyâ€™re putting patients at risk and driving up costs of cancer care.â€ť
In addition to quantifying the prevalence of cancer drug shortages, the authors also identified a variety of ways in which oncologists say theyâ€™ve adapted when preferred or recommended drugs are scarce:
- 78 percent of oncologists reported treating patients with a different drug or drug regimen
- 77 percent substituted different drugs partway through therapy
- 43 percent had to delay their patientsâ€™ treatment
- 37 percent had to choose among patients who needed a particular drug
- 29 percent omitted doses and 20 percent reduced doses
- 17 percent referred patients to another practice
So far, little is known about how these adaptations may impact clinical outcomes, but the authors say the widespread treatment delays reported underscores the urgency of the problem. The most risky types of modifications, Gogineni says, occur when physicians substitute drugs partway through patientsâ€™ treatments, since there is often no established dose equivalence or known safety profile when the substitute is combined with other therapies. Clinical trials are also hampered when drugs necessary for properly testing new regimens are scarce. The team found that nearly 12 percent of the time, drug shortages prevented enrollment in studies, delayed administration of a study drug, or suspended involvement of patients on clinical trials.
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