Mar 23, 2015
By Shira Klapper, Senior Writer/Editor
An article in the Journal of Oncology Practice (JOP) reports on a survey, conducted during 2012 and 2013, that asked oncologists to describe their experiences with oncology drug shortages. The study, published online, ahead of print, December 30, 2014, focused on two main questions: First, did doctors experience a shortage of any drugs, and if so, did they respond by using an equally effective or less-effective drug? Second, was the size and structure of the oncology practices associated with how the shortage was experienced?
Based on analysis of the survey data, the study, “Oncologists' Experiences with Drug Shortages,” found that 74% of the 330 respondents reported experiencing a shortage of at least one drug, 61% reported using an equally effective drug in light of the shortage, and 28% reported using a less effective alternative. The study also found that care providers experienced the shortage differently based on the size of their practices: Large, integrated health systems such as the Veterans Affairs (VA) were less likely to experience shortages, compared to smaller, community-based practices.
Commenting on the findings, study first author, Kenneth L. Kehl, MD, said the data cannot directly explain why the shortage impacted practices differentially. However, he said one hypothesis—as also stated in the JOP article—is that “physicians who are part of a larger, more integrated care delivery system might be better able to plan a response to a drug shortage. Another possibility is that larger organizations have more purchasing power or ability to engage in the market.”
Drug shortages have increased significantly in the United States in the past decade, with the years 2011 to 2012 being particularly severe. A survey of 214 ASCO members from 2012 to 2013 found that 83% of physicians had experienced shortages, and a survey of 462 ASCO members from April 2013 found that 59% of respondents experienced ongoing shortages (read this Connection cover story for an in-depth description of ASCO’s efforts to address the drug shortage).
Practice size and cancer type affect how drug shortages are experienced
The study surveyed 330 oncologists who were caring for patients in the Cancer Care Outcomes Research and Surveillance Consortium (CanCORS) from 2013 to 2013; CanCORS is a study of approximately 10,000 patients diagnosed with lung or colorectal cancer and their care providers. Specifically, the survey sought information about seven drugs: leucovorin, fluorouracil, dexamethasone, cyanocobalamin, paclitaxel, cisplatin, and etoposide. To determine whether practice type affected how the shortage was experienced, the survey asked oncologists whether they worked at a solo practice, single-specialty group practice, multispecialty group practice, HMO-affiliated site, or VA site.
In addition to the finding that VA oncologists were less likely to report experiencing a shortage of any drug, the study found that oncologists practicing in an HMO were less likely to report having to substitute a less-effective drug compared to single-specialty group practitioners. Also, doctors caring for patients with lung but not colorectal cancer were more likely to experience shortages compared to doctors who cared for patients with both lung and colorectal cancer.
Among the seven drugs listed in the survey, the study found that leucovorin was the drug most cited as being in short supply, with 66% of oncologists reporting a shortage of the drug. Leucovorin was followed by fluorouracil and dexamethasone, with 21% and 16% of doctors reporting shortages of these drugs, respectively.
Outreach to smaller practices
Dr. Kehl, whose research focuses on in improving health care delivery to patients with cancer, said that while the data could not directly assess the impact of drug shortages on patient outcomes, “some of the surveyed oncologists described potentially serious effects on patients because of these shortages.”
In addition to medical side effects, the study notes that substituting certain medications might contribute to the “financial toxicity” patients with cancer experience as a result of treatment; for example, levoluecovorin, an alternative to leucovorin, is forty times as expensive as leucovorin.
“These data might argue for the need for more concerted efforts to understand the factors underlying the shortage and to reach out to smaller practices that were disproportionately affected,” said Dr. Kehl.
Kenneth L. Kehl, MD, is an oncology Fellow at The University of Texas, MD Anderson Cancer Center. He has been an ASCO member since 2014.
Abstract of the original JOP article.
PDF of the original JCO article.
Kehl KL, Gray SW, Kim B, et al. Oncologists' experiences with drug shortages. J Oncol Pract. Epub 2014 Dec 30.
@ 2014 American Society of Clinical Oncology