Shortages of essential cancer drugs in the United States are causing disruptions in treatment for thousands of patients, according to experts. The Food and Drug Administration has identified over 10 drugs used in chemotherapy that are in short supply, leading hospitals to find new suppliers or adjust patient doses to ensure continuity of care. These shortages have been described as unprecedented and have prompted cancer centers to seek alternative treatments and suppliers. One example of a response to the shortage is the FDA’s authorization of the temporary importation of an unapproved chemotherapy drug from China. These shortages are attributed to disruptions in the supply chain caused by the COVID-19 pandemic, although drug shortages have been an ongoing issue. The impact of these shortages is particularly concerning for blood and bone marrow cancers, as many of the affected drugs are used in their treatment. Cancer centers have been forced to adjust doses, find new suppliers, and ration treatments to manage the shortages. In some cases, patients have been switched to older chemotherapy drugs that are less affected by shortages. However, there are concerns that the continued occurrence of shortages poses a threat to patient care and that patients should receive curative therapy without worrying about shortages. Cancer centers have implemented various strategies to address the shortages, including identifying new suppliers and rationing available drugs. Dose rounding, a technique that adjusts the prescribed dose down to the nearest vial size, has also been used to reduce drug waste. Although dose rounding does not appear to impact the short-term effectiveness of chemotherapy, its long-term clinical impact has not been extensively studied. Some cancer centers have not experienced treatment interruptions, but shortages have been reported across the country, particularly in community oncology centers. Smaller health systems have been particularly affected, leading to an increase in referrals to larger cancer centers. Importation of foreign drugs, such as the Chinese-manufactured cisplatin, has also been considered as an option. However, this process can be challenging due to the availability and safety considerations of these drugs. Despite the challenges, experts recognize the need to address the larger systemic issues that lead to drug shortages.
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