Coping With the Ongoing Cancer Drug Shortage
- A Wisconsin man, 60, was diagnosed with stage 4 bile duct cancer after experiencing back pains, which tests revealed to be cancer. After undergoing surgery, he was expecting multiple rounds of chemotherapy, but the ongoing chemotherapy drug shortage paused his treatment indefinitely, allowing the cancer to worsen. He passed away last December.
- Bile duct cancer, or cholangiocarcinoma, is a rare but aggressive form of cancer that quietly develops in the bile ducts, the vital pathways that transport bile (a digestive fluid) from the liver to the small intestine. This cancer is hard to detect early on due to its subtle symptoms, including abdominal pain, jaundice, fatigue, and fever – which can be easily mistaken for something else.
- SurvivorNet has found that the supply of some mainstay drugs, namely platinum-based chemotherapy drugs like cisplatin, carboplatin, and oxaliplatin, is significantly variable. These drugs are widely used in treating many types of cancer, including breast, lung, ovarian, bladder, and testicular cancers.
- The shortage has been an ongoing issue for years. However, in early 2023, it reached a critical point, prompting the U.S. Food and Drug Administration (FDA) to announce a shortage of chemotherapy drugs cisplatin and carboplatin. SurvivorNet reports that although the drug shortage has impacted larger, more resourced facilities, smaller community care facilities have been hit even harder.
- Earlier this year, Cancer Cytopathology, a peer-reviewed publication of the American Cancer Society, said generic cancer drugs are still in short supply, forcing some hospitals to continue rationing drugs.
- To help navigate the ongoing drug shortage, patients are encouraged to explore all their treatment options with their care team. This may include traveling to a nearby facility for available treatment. Patient navigators and social workers are also available to assist with this.
A Wisconsin man diagnosed with stage 4 cancer was on track with his treatment until the cancer drug he desperately needed ran out due to the ongoing cancer drug shortage. He passed away seven months after he couldn’t get the chemotherapy he needed for treatment. SurvivorNet has found significant variation in the supply of some mainstay drugs, namely platinum-based chemotherapy drugs like cisplatin, carboplatin, and oxaliplatin. These drugs are widely used in treating many types of cancer, including breast, lung, ovarian, bladder, and testicular cancers. The shortage has been an ongoing issue for years. However, in early 2023, it reached a critical point, prompting the U.S. Food and Drug Administration (FDA) to announce a
shortage of chemotherapy drugs cisplatin and carboplatin.
Earlier this year, Cancer Cytopathology, a peer-reviewed publication of the American Cancer Society, said generic cancer drugs are still in short supply, forcing some hospitals to continue rationing drugs. “This is the most critical chemotherapy shortage I’ve ever seen, and this is. Certainly, a public health emergency,” the director of gynecology oncology clinical trials at Duke Cancer Institute,
Dr. Angeles Alvarez Secord ,
said in the report. “It breaks my heart that you have cancer patients – or any patient for that matter – going through this,” Dr. Secord added. This happened to Jeff Bolle of Milwaukee, WI, last year. Bolle was a high school football coach who was diagnosed with bile duct cancer in 2022.
Bile duct cancer , or cholangiocarcinoma, is a rare but aggressive form of cancer that quietly develops in the bile ducts, the vital pathways that transport bile (a digestive fluid) from the liver to the small intestine.
WATCH: Understanding bile duct cancer and how it is treated. “When we consider bile duct cancer, it usually gets kind of swept under the same shingle as liver cancer, but it is not the same thing, and treatment approaches can be very different,”
Dr. Mariam F. Eskander , a surgical oncologist and assistant professor of surgery at the Rutgers Cancer Institute of New Jersey, tells SurvivorNet. “Bile duct cancers can also affect the bile duct system that runs from within the liver to outside the liver. So, we have what are called intrahepatic cholangiocarcinomas, that is bile duct cancer within the liver. And extrahepatic bile duct cancers, which are cholangiocarcinomas that are outside of the liver,”
Dr. Elliot Newman , the chief of surgical oncology at the Northwell Health Cancer Institute at Lenox Hill Hospital in Manhattan, tells SurvivorNet. Bile duct cancer often first shows up in the later stages with subtle symptoms that can be mistaken for less severe conditions. These subtle symptoms can easily be mistaken for something else and may include:
- Itching
- Fever
- Fatigue
- Jaundice
- Dark urine
- Abdominal pain
As for Jeff Bolle, his symptoms began in October 2022 when he started experiencing back pain. He thought he pulled a muscle during exercise, but after going to see his doctor, tests revealed he had stage 4 bile duct cancer. After his diagnosis, his care team soon developed a treatment plan. Last year, Jeff Bolle explained to the “Today Show” what he anticipated. “Their thoughts were that they could get most of the tumor out, and they could use chemo to hold it off,” Jeff Bolle
said . Jeff Bolle underwent surgery and received four rounds of cisplatin chemotherapy. However, by the Spring of 2023, the cancer drug shortage was at Jeff’s front door. The chemotherapy shortage caused his treatment to stop suddenly. “He was never able to get on cisplatin (again). His cancer was continuing to grow, and his bile ducts were getting compromised because the cancer was pushing on them even more. He was really getting so very sick. It was horrible,” Jeff’s wife Connie described. As Bolle’s condition deteriorated, Connie said, “There was nothing else they could do, which was hard to hear. There was no immunotherapy. There was no other chemotherapy.” Jeff died in December 2023 after he lost access to cisplatin chemotherapy.
Help With Navigating Cancer Treatment
The Impact on Hospitals
The report in Cancer Cytopathology indicated that, based on a National Comprehensive Cancer Network survey, the vast majority (93%) of academic cancer centers experienced a shortage of carboplatin and cisplatin (70%). Smaller hospitals were hit harder by the drug shortage due to fewer resources. Allegheny Health Network (AHN) told SurvivorNet they have been monitoring their supply closely. “To minimize the impact of shortages on patients, AHN is employing many different solutions, including managing existing supply, seeking alternative sources for drugs in short supply, adjusting chemotherapy regimens for impacted patients, and working with healthcare providers to mitigate these challenges,” said Jodi Lech, Pharm.D., BCOP, Director of Pharmacy, Hematology/Oncology at AHN. Chief medical officer Dr. Vijay Trisal told SurvivorNet, "Like many other hospitals and health care systems nationwide, City of Hope is affected by the national shortage of certain chemotherapy drugs.” "We are developing mitigation strategies through a dedicated team of integrated staff across our national cancer care system. We remain committed to using every available resource in providing the very best care for our patients," Dr. Trisal continued.
What Caused the Drug Shortage?
As some lawmakers pointed out in previously released reports, the drug shortage has been on the horizon for years. There is speculation that drug makers producing older chemotherapy drugs have little incentive to maintain large-scale production because they are no longer patent-protected. Once the patent expires, the drugs become less profitable as the generic drug market takes hold. Other areas of concern involve disruptions in the drug manufacturer’s supply chain. The New York Times previously
reported on problems at manufacturing plants in China and India disrupting the flow of key ingredients needed to produce the drugs. Overseas drug manufacturers have also experienced production slowdowns due to quality control issues. The FDA released a
report on India-based
Intas Pharmaceuticals , claiming it “lacked adequate oversight” during an inspection last year.
Dr. Lucio Gordan of Florida Cancer Specialists highlighted these issues: “The root causes include low price point of some generics below the cost of production, relatively low investment in this business line. At this point, we are in critical need of change. Our practice has joined many others in the oncology community to ask for legislative support in the regulation of pricing for these crucial drugs.” U.S.-based drug companies ramped up the production of needed drugs to fill the void, but supplies have not reached healthcare facilities in large quantities yet.
Fresenius Kabi produces carboplatin, and a spokesperson for the company previously told SurvivorNet that it has “prioritized production” of the drug to compensate for the shortage. “However, it will take several weeks to ramp up the production.”
Helping Patients Navigate the Drug Shortage
Cancer patients and their loved ones who help them along their journeys may wonder what to do if the cancer drug they need is not available. SurvivorNet spoke with experts like social workers and patient navigators and consulted national organizations like City of Hope and CareCare to provide recommendations to help people find solutions.
- Push for answers. Bring a care partner to your appointments to help you listen, take notes, and process the information. Don't rest until you are satisfied with your care and the decision-making process.
- Evaluate other options. In most cases, there are other treatment options. According to physicians who spoke to SurvivorNet, evaluating potential alternatives when the specific drug you are used to is not available is a conversation that should be had with your care team.
- Consider traveling. While traveling to a different area to get the cancer drug you need is not always feasible, it should be considered. Try calling various pharmacies and hospitals to determine treatment availability.
- Seek out a patient navigator. Knowing the right questions or who to contact can be daunting, but patient navigators are there to help. They provide personalized support for patients.
- Connect with an oncology social worker. Like patient navigators, oncology social workers are there to help you get answers to questions and provide emotional support. Oncology social workers are licensed professionals trained to help people affected by cancer.
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