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80 Percent of Cancer Docs in U.S. Have Faced Drug Shortages

Posted December 20, 2013

Four out of five doctors who treat cancer were unable to prescribe their medication of choice at least once during a six-month period because of a drug shortage, according to a new survey.

The survey also found that more than 75 percent of oncologists were forced to make a major change in patient treatment. These changes included altering the regimen of chemotherapy drugs initially prescribed and substituting one of the drugs in a particular chemotherapy regimen.

Such changes might not be well studied, and it might not be clear if the substitutions will work as well or be as safe as what the doctor wanted to prescribe, experts say.

“The drugs we’re seeing in shortages are for colon cancer, breast cancer and leukemia,” said Dr. Keerthi Gogineni, an oncologist who led the team conducting the survey. “These are drugs for aggressive but curable [cancers]. These are our bread-and-butter drugs for common cancers, and they don’t necessarily have substitutes.”

“When we asked people how they adapted to the shortages, they either switched combinations of drugs or switched one drug within a regimen,” said Gogineni, of the Abramson Cancer Center and Perelman School of Medicine at the University of Pennsylvania. “They’re making the best of a difficult situation, but, truly, we don’t have a sense of how these substitutions might affect survival outcomes.”

Results of the survey were published as a letter in the Dec. 19 issue of the New England Journal of Medicine. The survey included more than 200 physicians who routinely prescribe cancer drugs.

When substitutions have to be made, it’s often a generic drug that’s unavailable. Sixty percent of doctors surveyed reported having to choose a more expensive brand-name drug to continue treatment in the face of a shortage.

The difference in cost can be staggering, however. When a generic drug called fluorouracil was unavailable, substituting the brand-name drug Xeloda was 140 times more expensive than the desired drug, according to the survey.

Another option is to delay treatment, but again, Gogineni said, it’s not clear what effect waiting might have on an individual patient’s cancer. Forty-three percent of oncologists delayed treatment during a drug shortage, according to the survey.

Complicating matters for doctors is that there are no formal guidelines for making substitutions. Almost 70 percent of the oncologists surveyed said their cancer center or practice had no formal guidelines to aid in their decision-making.

Read more at: MedlinePlus

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