US doctors forced to ration as cancer drug shortages hit nationwide

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Toni Dezomits during chemotherapy

Toni Dezomits had to change her ovarian cancer treatment plan due to a shortage of chemotherapy drugs

Toni Dezomits, a 55-year-old retired law enforcement officer, is battling a recurrence of her stage 4 ovarian cancer. She had already undergone several rounds of chemotherapy when her doctor told her he had more bad news.

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Just a day before her third round of treatment last month, Ms. Dezomits was told there was a nationwide shortage of the generic chemotherapy drug, carboplatin, one of three drugs she was due to receive.

Forced to choose between giving up the drug or replacing it with one with stronger side effects, the North Carolina native is finishing her last three chemotherapy sessions on just two of the recommended drugs.

“You have these two suboptimal choices,” he said. “I’m concerned, because I know the drug I’m not taking is one that my cancer has responded to very well [the first time].”

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Experts say the United States is currently suffering from one of the most severe shortages of chemotherapy drugs to have occurred in three decades.

Ms Dezomits is one of about 100,000 patients who may have been affected in recent months, according to Dr. Julie Gralow, chief medical officer at the American Society of Clinical Oncology.

As of this week, the US Food and Drug Administration (FDA) said more than 130 drugs are in short supply, 14 of which are cancer treatments.

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Experts say a myriad of factors contributed to the shortage, which this time hit two front-line therapies – carboplatin and cisplatin – used to treat a range of cancers, including head and neck, gynecological and gastrointestinal cancers.

The most recent shortage occurred after the closure of a plant in India, which was supplying cisplatin materials to all US manufacturers, due to quality issues. This has increased demand for a replacement drug, carboplatin, Dr. Gralow said.

As a result, some providers have been forced to extend the time between patients’ chemotherapy sessions, while some patients have had to drive for several hours to receive treatment at different cancer centers.

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When her local oncologist couldn’t provide her with carboplatin, Ms. Dezomits tried a larger cancer center in Texas, where she had been before. But she was told they couldn’t give her the drug because they were giving priority to patients more likely to be treated.

“It’s like battlefield triage,” said Ms. Dezomits, who was a soldier in the Persian Gulf War. “This country should be a little better than that. We should be able to get life-saving drugs that cost about $9 or $10 a dose.”

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Carboplatin chemotherapy drug

The chemotherapy drugs carboplatin and cisplatin were hit hardest by the shortage

The low cost of generic first-line cancer drugs has actually played a role in the recurring shortage of chemotherapy drugs, experts say. While the drugs are cheap to make, drug companies have no incentive to do so because they don’t bring in large profits, said Dr. Karen Knudsen, CEO of the American Cancer Society.

The problem of drug shortages has also worsened as life expectancy in the United States has increased, which means that more and more people are getting cancer.

To help ease supply chain crises, the FDA this week began working with a Chinese manufacturer to import one of the chemotherapy drugs.

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The move will likely help resolve some short-term supply constraints in the coming months, but will do little to address a more cyclical problem of chemotherapy drug shortages, said Dr. Knudsen.

“An emergency solution is being implemented, but we are at a time where a more lasting solution is needed,” he said.

Medical experts have said the US government should work with the private sector to find more long-term solutions.

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The US government could use its drug purchase dollars to create national strategic stockpiles of critical drugs and incentivize higher-quality pharmaceutical companies to produce them, Dr. Gralow said.

The patient, Ms. Dezomits, fears that without further action, people in the United States could continue to find themselves in difficult situations to find the cancer treatment they need.

“It’s stressful enough dealing with cancer and your own mortality,” she said. “This is just another hurdle ahead of patients who now have to think about.”

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