As cancer drug shortages grow, some doctors are forced to ration doses or delay treatment

Widespread cancer drug shortages are forcing doctors to make difficult decisions about how to treat their patients, including dose rationing and switching to other treatment options with potentially more side effects.

As of Wednesday, the Food and Drug Administration has listed 14 cancer drugs in short supply.

The oncology shortage is especially critical, FDA Commissioner Dr. Robert Califf told NBC News. I\’m a former intensivist doctor and I\’m very aware of the consequences if you can\’t get the chemo you need.

According to a March report by the Senate Committee on Homeland Security and Governmental Affairs, the drug shortage has reached record highs. The shortage of new drugs increased by almost 30% between 2021 and 2022. At the end of 2022, there was a five-year record of 295 active drug shortages.

I don\’t know of a worse time than this, said Dr. Julie Gralow, chief medical officer and executive vice president of the American Society of Clinical Oncology. What\’s different about this shortage is, I think, it\’s just the broad applicability of these drugs, how important they are, you know, globally, in the United States, in treating many diseases.

Among the drugs in shortage is carboplatin, a chemotherapy agent used as a first-line treatment for a range of cancers.

Carboplatin is such an important drug for treating many cancers such as breast cancer, ovarian cancer, head and neck cancer, lung cancer, among many others, said Dr. Lucio Gordan, medical oncologist and president of the Florida Cancer Specialists and Research Institute, a network of cancer clinics. Gordan said they were completely off the drug for nearly two weeks.

I\’ve been doing it for more than 20 years. This is the worst I\’ve ever seen, she said.

Florida cancer specialists knew the shortage was coming and tried to prepare. For the past two months, they\’ve been rationing rounding carboplatin doses by 10 percent, which Gordan says doesn\’t diminish the drug\’s effectiveness.

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We\’ve rounded down for a while, he said. But we just ran out of drugs, so there\’s nothing to round up.

Carrie Cherkinsky, 41, of Tallahassee, Florida, learned of the shortage from a Facebook support group for women with ovarian cancer. Even so, she was shocked to learn that she would not be able to get her second round of chemotherapy, scheduled for May 15, at Florida Cancer Specialists. Gordan was not involved in her care.

Who will be held responsible for this? said Cherkinsky, who was diagnosed with ovarian cancer in March. For me not getting life-saving treatment?

Carboplatin is not only an effective drug; it is also less toxic and causes fewer side effects than other available drugs.

However, one of the problems with these alternative drugs is that they\’re often not that good, so they could compromise survival outcomes, said Dr. Angeles Alvarez Secord, president of the Society of Gynecologic Oncology.

Also, when there\’s more toxicity, there\’s a higher cost to treat because you\’re also dealing with side effects or are giving additional medications to try to prevent side effects, Secord said. So alternatives often, even if they are present, still don\’t meet the best standard of care.

Nationwide, hospitals and cancer centers have been forced to make similar decisions when it comes to cancer treatments.

According to a May survey conducted by the Society of Gynecologic Oncology, doctors in at least 40 states have at least one chemotherapy drug in short supply.

Dr. Eleonora Teplinsky, a breast and gynecological oncologist at Valley Health System in New Jersey, said the shortages are devastating.

Cancer is life changing as it is, but you expect as a patient that you will walk into an office and be given the best there is, Teplinsky said. And right now we don\’t have the best to give certain types of cancer.

Drug shortages cause additional stress not only for cancer patients but also for healthcare professionals. In addition to being part of a workforce already exhausted and exhausted by a pandemic, doctors must scramble to find life-saving treatment.

All practices in the country, not just oncology, have been under a lot more stress since Covid, Gordan said. This is another curveball that keeps us from doing the best we can.

Shortages can sometimes catch suppliers off guard.

Suppliers do not warn when a drug is running low; they\’ll just stop filling all their orders, said Andrea Iannucci, assistant chief pharmacist at UC Davis Health. So we place an order and think it\’s going to arrive and it doesn\’t, because the drug wasn\’t available, Iannucci said.

Keri Carvill, 44, of Sacramento, Calif., was diagnosed with triple-negative breast cancer in March but wasn\’t able to get her first dose of carboplatin until May 19. Triple negative breast cancer is a particularly aggressive form of the disease.

It\’s stressful and scary, Carvill said.

What led to the shortage and what can solve it?

The current carboplatin shortage has been caused in part by quality issues at a manufacturing plant, Intas Pharmaceuticals, in India, but experts say the real problem is more chronic.

Unfortunately, the profitability of this industry is very low or non-existent, Califf said. A number of companies are failing or experiencing quality problems due to difficulties investing in their technology. This is the main reason behind the shortage that we were seeing.

In a statement to NBC News, Intas Pharmaceuticals said it is working with the FDA to release existing inventory of carboplatin and other medically necessary products. He\’s also working with the agency on a plan to resume production, but added that a date hasn\’t been confirmed yet for when that will happen.

Califf said the FDA is working with other manufacturers to make more carboplatin available.

Long-term solutions, however, will require Congressional and White House intervention to put this industry in the right place, he said, adding that a White House team has been working on the drug shortage issue.

Teplinsky, the New Jersey-based oncologist, said she has encouraged her social media followers to reach out to elected officials to advocate for the timely production of chemotherapy drugs and long-term policies to ensure this doesn\’t happen again.

Delaying treatment affects outcomes, Teplinsky said. And so in this case, either we can\’t give people what they need, or we have to wait, which we know will lead to negative consequences.Follow NBC HEALTHCARE ON Chirping & Facebook.

This article was originally published on NBCNews.com