Manali I. Patel, MD, MPH, MS, is an associate professor at Stanford University in the Division of Oncology and a staff thoracic oncologist at the Veterans Affairs Palo Alto Health Care System. Dr. Patel is the 2023 Cancer.Net Associate Editor for Health Equity. Ana Velázquez Mañana, MD, MSc, is an assistant professor of medicine in the University of California, San Francisco (UCSF) Division of Hematology/Oncology at Zuckerberg San Francisco General and a thoracic oncologist. She is also the assistant director for trainees of the UCSF Helen Diller Family Comprehensive Cancer Center Office of Diversity, Equity, Inclusion, and Accessibility. You can follow Dr. Patel and Dr. Velázquez Mañana on Twitter. View disclosure information for Dr. Patel and Dr. Velázquez Mañana.
If you or a loved one has cancer, you may have recently heard news about drug shortages for certain cancer medications. Among these shortages include the chemotherapy drugs cisplatin and carboplatin, which are both available as generic drugs. A drug shortage occurs when the demand or anticipated demand of a certain drug is greater than the available supply of the drug.
The U.S. Food and Drug Administration (FDA) tracks drug shortages within the United States and compiles this information into a list so health care providers know which medications are currently in shortage or will be affected by expected shortages. However, sometimes there are delays in health care providers receiving this information, as the companies that make the drugs may not alert the FDA or providers right away about upcoming shortages. Often, the notification occurs after a shortage is already in place.
If your cancer treatment plan includes a drug that is in shortage, you might be worried about how this could affect your care. Here, learn more about what causes a drug shortage, how a shortage might affect your treatment plan, and what you and your health care team can do if a drug shortage occurs.
What causes a drug shortage?
There can be many different reasons a drug shortage occurs. These may include quality issues during the manufacturing process of the drug, production delays, an increase in demand for the drug, or even that the drug has been discontinued.
However, most drug shortages are thought to be caused by low profits for generic drugs. Often, producing these generic drugs does not lead to a profit for the companies that make them, so there are fewer manufacturers for generic drugs. Because of this, countries may rely on only a few manufacturers to produce the drug. If there are production problems with any of those manufacturers, there can be negative consequences, including supply issues in producing the drug and not enough medication to meet demand. This can, in turn, lead to a drug shortage.
Long-term solutions to drug shortages will require changes in drug manufacturing processes and procedures to make sure that these shortages don’t happen again, including through possible government actions, such as Congress passing new laws around this system.
How can a drug shortage impact care for people with cancer?
A drug shortage can negatively impact people with cancer in a variety of ways. A shortage may lead to delays in care, such as delays in starting treatment, or can interrupt a current treatment plan. A different treatment may need to be given if the preferred drug is not available. For example, if a patient’s treatment plan is depending on carboplatin and cisplatin—drugs that have been in shortage as early as February 2023—their oncologist may have to switch their treatment to another drug.
Sometimes, clinics may make decisions to give smaller amounts of the drug in shortage to each patient so that there is more to share, or they may increase the periods between when the drug is given. For example, cancer treatment may be given every 4 weeks, instead of every 3 weeks, if the drug is in shortage. However, in cases where the doctor has recommended a lower dose or longer periods between when the drug is given, this dose or time period will still fall within acceptable ranges tested in previous clinical trials.
When there are extreme drug shortages, clinics often have to make very difficult decisions. This may mean only giving the drugs to the patients who are likely to benefit the most from them, such as those who need the medication to cure the cancer. Clinics may also need to pause or stop adding patients to cancer clinical trials if one or more of the drugs are in low supply.
Decisions regarding how a clinic manages a drug shortage should be made by committees at each local clinic. This committee can monitor the drug shortage and help ensure that drugs that are in short supply are distributed equitably. Talk with your health care team about how your clinic makes treatment decisions during a drug shortage.
What will the health care team do during a drug shortage?
If the drug you are taking is experiencing a shortage, your doctor will talk with you about the next steps in your treatment plan. Your health care provider may turn to professional cancer societies for help, such as the American Society of Clinical Oncology (ASCO), which provides guidance and recommendations for providers to follow during a drug shortage.
If a drug you are taking is in shortage, your clinic should notify you about the shortage and let you know how this may change your treatment plan until the shortage is resolved. As explained above, these changes may include receiving a lower dose of the drug, increasing the period between treatments, or switching to a different drug altogether. Sometimes, your health care provider may decide that they will wait until more supply becomes available to start treatment. These options will be discussed with you in detail, and you should also feel free to ask questions about these plans, such as those outlined below.
What can you do if there is a shortage of the drug you are taking?
Drug shortages can be very concerning and may make you more worried or anxious about your cancer treatment and your overall care. Drug shortages can also make doctors worried and stressed about how to make sure their patients receive the best treatment possible without any delay.
The first step you should take during a drug shortage is to ask your doctor if they know of any shortages of the medications in your treatment plan so that you can prepare together. If there is a shortage, you can ask about whether there is enough of the drug available to complete your planned treatment or if there are any equivalent alternatives to the proposed treatment.
Talking with other people with cancer who may be experiencing the same concerns as you is always beneficial, too, and some clinics may have support groups for patients to attend to discuss these worries. Asking for a referral to a mental health counselor can also help if you want to talk to a clinician about your concerns.
Questions to ask the health care team during a drug shortage
If you are concerned about a drug shortage impacting your care, you can start a conversation with your health care team by asking the following questions:
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Are any of the drugs in my treatment plan currently experiencing a shortage?
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If so, how will this shortage impact my care? Will my treatment be delayed, or will I receive a different drug?
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Are there alternative ways to receive the drug, such as by mouth instead of by infusion?
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Will my treatment dose be reduced?
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If I receive a reduced dose of the drug or receive a different drug, will it be as effective as the dose or the drug that I was previously taking? If not, what should I expect?
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Will the period between my treatments be increased?
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What side effects can I anticipate from receiving a different drug?
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How will I know when my previous treatment has become available again?
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Will I resume my previous treatment as soon as the drug becomes available again?
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What can I do if there is a shortage of a drug I am receiving?
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What support services are available, such as support groups or mental health counselors, to help me cope with the stress of this drug shortage?
