Am J Health Syst Pharm. 2014 Apr 1;71(7):571-578.

Impact of shortages of injectable oncology drugs on patient care.

Goldsack JC1, Reilly C, Bush C, McElligott S, Bristol MN, Motanya UN, Field R, Vozniak JM, Wong YN, Schwartz JS, Domchek S.

Author information

• 1Jennifer C. Goldsack, MChem., MA(Oxon), M.S., is Research Associate, The Value Institute, Christiana Care Health System, John H. Ammon Medical Education Center, Newark, DE. Cynthia Reilly, B.S.Pharm., is Director, Medication Safety and Quality Division; and Colleen Bush, B.A., is Manager of Market Research, American Society of Health-System Pharmacists, Bethesda, MD. Sean McElligott, B.S., M.S., is Senior Biostatistician and Economist, Division of General Internal Medicine; Mirar N. Bristol, M.A., is Project Director, General Internal Medicine; and U. Nkiru Motanya, B.S., is Researcher, General Internal Medicine, University of Pennsylvania, Philadelphia. Robert Field, Ph.D., M.P.H., J.D., is Professor, Department of Health Management and Policy, Drexel School of Public Health, Drexel University, Philadelphia, PA. J. Michael Vozniak, Pharm.D., BCOP, is Associate Director of Pharmacy, Professional Practice, Hospital of the University of Pennsylvania, Philadelphia. Yu-Ning Wong, M.D., MSCE, is Attending Physician, Medical Oncology, and Assistant Professor, Fox Chase Cancer Center, Philadelphia. J. Sanford Schwartz, M.D., is Leon Hess Professor in Internal Medicine, Division of General Internal Medicine; and Susan Domchek, M.D., is Basser Professor in Oncology, Department of Medicine, University of Pennsylvania, Philadelphia.

Abstract

PURPOSE:

Results of a survey regarding shortages of injectable oncology drugs in U.S. hospitals and health systems are presented.

METHODS:

An online survey was sent to all members of the American Society of Health-System Pharmacists self-identified as directors of pharmacy. Survey participants provided information on the extent to which their facilities were affected by oncology drug shortages, strategies for responding to shortages, and the effects of shortages on costs, patient safety, and outcomes.

RESULTS:

Ninety-eight percent of the 358 survey respondents reported at least one drug shortage during the previous 12 months, with 70% reporting instances of an inadequate supply to treat patients and 63% reporting that their facility had completely run out of at least one injectable oncology drug. Sixty-two percent of respondents reported using alternative drug regimens due to shortages; 46% reported drug dosage changes, 43% reported treatment delays, and 21% reported patient referrals to or from other facilities as a result of shortages. Survey respondents indicated the use of various strategies to manage oncology drug shortages (e.g., increasing inventories of certain drugs, identifying alternatives and substitution protocols, altered purchasing practices), all of which have led to cost increases. Twenty-five percent of respondents reported safety events resulting from oncology drug shortages. Only 40% of respondents agreed that currently available information is useful in mitigating the effects of shortages.

CONCLUSION:

Shortages of injectable oncology drugs appear to be widespread and to be having a significant impact on patient care. Currently available information about shortages does not meet administrative or clinical needs.