A 'life-threatening' shortage of cancer drugs has Kansas doctors rationing medications
By Rose Conlon / Kansas News Service
June 7, 2023, 9 a.m. ·
For over a month, doctors at AdventHealth Shawnee Mission Cancer Center have struggled to get their hands on enough chemotherapy drugs to treat their patients.
First, their shipments of carboplatin — typically used to treat breast, ovarian and several other cancers — were delayed. They were able to switch some patients onto cisplatin, another platinum-based drug that’s similarly effective but can have more side effects.
Then, their cisplatin shipments stopped arriving on time.
To make dwindling supplies stretch longer, doctors began rounding patients’ doses down by as much as 10% — within professional guidelines — and began bracing for the need to take more drastic action if the shortage persists.
It’s part of a nationwide shortage of more than a dozen essential cancer drugs that’s forced Kansas health care providers to ration medication and consider delaying some treatments altogether.
“I lose sleep over this,” AdventHealth oncology pharmacist Kyla Bidne said. “This shortage is the worst that I remember — and I’ve been in practice for about 20 years now.”
At one point, supplies got so low that her team planned to move some patients to a different drug class entirely — only to walk in that morning and find a surprise shipment of the drug they needed.
“We really don’t know from day to day when we’re going to receive drugs, or if we’re going to receive drugs,” Bidne said. “We have to plan for the worst and hope for the best.”
The U.S. has long been susceptible to drug shortages, but they’re becoming more frequent and lasting longer. New drug shortages increased by nearly 30% between 2021 and 2022 according to a U.S. Senate committee report that described the issue as a national security risk.
Drug supply chains offer little transparency about what is driving a particular shortage or how long it might last. That, in turn, makes it harder for government officials to respond.
The causes range from supply chain disruptions to quality issues, to outsized reliance on overseas manufacturers, to export restrictions in origin countries and fluctuations in demand. The pandemic exacerbated existing supply chain vulnerabilities, triggering global shortages.
But the cancer drug shortages — which have jeopardized treatment for a wide range of adult and pediatric patients — are particularly problematic because getting timely treatment can mean the difference between life and death.
“In some cases, there is not a good alternative drug that has the same effectiveness,” said Dr. Lisa Holle, a clinical professor at the University of Connecticut School of Pharmacy. “So it can be extremely detrimental and potentially life-threatening.”
Testicular cancer, for instance, is usually curable even when it’s caught at advanced stages — with cisplatin. Not being able to access the drug, she said, might put a cure out of reach for some patients.
Kansas doctors worry they could soon have to make wrenching choices about which patients to prioritize for treatment.
“That is a terrible decision,” said Dr. Verda Hicks, president of the American College of Obstetricians and Gynecologists and a Leawood, Kansas,-based gynecological oncologist. “It’s very hard to place value on someone’s life.”
Small hospitals often feel the squeeze first because larger cancer centers usually have more reserve stock to fall back on and have more buying power when they’re purchasing a limited quantity of drugs from wholesalers.
“It’s hard to predict when an institution or a patient will be affected,” Holle said. “Every day, the situation is changing because of 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 indicated it’s also exploring options for importing more carboplatin.
But it’s uncertain how immediate the relief will be — and how many patients will be impacted before the problems are resolved.
“Everybody’s very concerned about this,” Holle said. “It’s not clear what sorts of legislative changes can make these shortages go away long-term. But we have to start thinking about how we can handle these sorts of things.”