Impact of oncology drug shortages.

Health Services Research
Session Type and Session Title: 
Clinical Science Symposium, Bridging Evidence to Clinical Care: Cost and Availability of Treatment
Abstract Number: 
J Clin Oncol 31, 2013 (suppl; abstr CRA6510)
Ezekiel J. Emanuel, Katie Shuman, Derek Chinn, Keerthi Gogineni; Perelman School of Medicine and The Wharton School, University of Pennsylvania, Philadelphia, PA; University of Pennsylvania, Philadelphia, PA; Hospital of the University of Pennsylvania, Philadelphia, PA

Abstracts that were granted an exception in accordance with ASCO's Conflict of Interest Policy are designated with a caret symbol (^).

Abstract Disclosures


Background: Drug shortages of common chemotherapeutics have been reported. What is the prevalence and consequence of these shortages? Methods: Between 9/2012 and 1/2013, a self-administered questionnaire was sent to a random sample of 455 board-certified U.S. oncologists selected from the American Society of Clinical Oncology directory to assess the prevalence of shortages and impact on therapeutic decision-making. 245 responses were received (response rate 55%), of whom 210 were practicing medical oncologists/hematologists. Results: Due to drug shortages in the prior 6 months, 92% (163) of oncologists reported that their patients’ treatment was affected and 83% (174) were unable to prescribe standard chemotherapy. The five chemotherapy agents most commonly reported in shortage were: leucovorin (68%), liposomal doxorubicin (63%), 5-FU (19%), bleomycin (18%), and cytarabine (17%). Physicians adapted in many ways. 38% of the time, oncologists substituted more expensive branded drugs for those in shortage, such as levoleucovorin for leucovorin. Nearly 13% of the time, shortages prevented enrollment, delayed administration of a study drug, or suspended involvement of patients on clinical trials. Despite the prevalence of scarcities, 70% (146) of oncologists reported their cancer centers or practices lacked formal guidance for allocation decisions. Conclusions: Drug shortages in oncology are very common, compromise the delivery of standard care, impede research, and lead to higher costs by using branded drugs instead of generics. Oncologists also seem to lack formal guidance on how to address these shortages.

Adaptation to drug shortage Number of oncologists
reporting modification
Switch regimens 79%
Substitute drug partway through therapy 77%
Delay treatment 43%
Choose among patients 37%
Omit doses 29%
Reduce doses 20%
Refer patients to another practice 17%