At one New York medical center, half of the cancer patients required drugs that were considered in short supply in 2010 and 2011, and 10% were forced to receive an alternative, according to a study presented at the 2012 ASCO Annual Meeting (Abstract 6114).
While the investigators hope that this did not compromise efficacy, about one-third of the time the physicians felt the substitute was inferior, said Daniel J. Becker, MD, of St. Luke’s-Roosevelt and Beth Israel Medical Center, New York, who led the study presented at ASCO.
Becker reported that drugs considered in shortage were used for 51% of patients in 2010, and this increased significantly to 64% in 2011.
“When the shortage reached critical levels, about 10% of the patients we treated had an actual change in treatment mandated by the shortage,” he told The Oncology Nurse-APN/PA.
The researchers reviewed pharmacy records for drug shortages, defined as supply issues that affect how the pharmacy prepares or dispenses a drug product or influences patient care when prescribers must use an alternative agent, and examined records of outpatients who received chemotherapy from April 2010 to September 2010 (n = 335) and from April 2011 to September 2011 (n = 379). They also surveyed physicians about the efficacy and toxicity of the alternative regimen used during the shortage.
The percentage of drugs in shortage increased from 30% in 2010 to 50% in 2011, and the percentage of patients treated with a shortage drug increased from 51% to 65%. Most of the shortages occurred in breast cancer patients (48%), followed by gynecologic cancer patients (26%).
Of the 235 patients in the subgroup examined in August/September 2011 (when shortages peaked), 23 (9.8%) experienced a change in therapy, he reported. No substitutions occurred in 2010.
Three medications were unavailable at St. Luke’s-Roosevelt: paclitaxel (74%), liposomal doxorubicin (22%), and 5-fluorouracil (4%). Leucovorin was also in short supply, but the consequences were difficult to track for this project, since most patients continued to receive the drug in reduced dosages, Becker said.
As a substitute for paclitaxel, the use of docetaxel increased by 80%, while paclitaxel decreased by 69% during the most critical period. The estimated cost of a single treatment with paclitaxel for the average patient was $47, versus $858 for docetaxel, a 1704% increase, Becker pointed out.
“When we surveyed treating physicians about the change in therapy, we found that they considered the alternative regimen inferior to the standard regimen in 30% of patients and thought the alternative regimen was more toxic in around 35%,” Becker said.
Today, he added, “Many drugs are still in shortage, but few affect care on a daily basis. There is definitely progress, though there is still vulnerability.”
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