Over the past 3½ years, Dorothy Schwaninger has been on chemotherapy to battle ovarian cancer.
Treatment went well until her oncologist’s office called with surprising news. She would need to postpone her appointment because the doctor couldn’t get the drug she needs.
“I’ve never heard of such a thing. I thought that can’t be right,” said 82-year-old Schwaninger, of Yukon.
Schwaninger is among the growing number of cancer patients caught up in a nationwide chemo drug shortage that a doctor says will lead to an epidemic of avoidable deaths.
“The gains in the curable malignancies have resulted from a hard-fought war, and now it is particularly galling to see the slow, steady and continued emergence of a national travesty — the shortage of cytotoxic drugs, which will certainly lead to an epidemic of avoidable deaths,” Dr. Derek Raghavan, president of the Levine Cancer Institute in Charlotte, N.C., writes in the Sept. 1 issue of The American Society of Clinical Oncology Post.
A total of 17 mainstay drugs used in chemotherapy are currently in short supply, said Mike Cohen, president of The Institute for Safe Medication Practices.
“The shortage is pretty severe right now. It’s pretty scary,” he said.
Dr. Shubham Pant, oncologist with the Peggy and Charles Stephenson Oklahoma Cancer Center, said health care providers have to be agile to deal with the toughest year he’s ever seen for chemotherapy products. He said the absence of needed drugs has forced the center to put patients on alternative drugs and postpone clinical trials.
“We deal with the shortage of one drug and then we deal with the shortage of another drug. It’s been kind of one drug after another,” he said.
Keith Madison, pharmacy director at Mercy Health Center and a pharmacist for more than three decades, agreed.
“I think the overall shortage of pharmacy products is most significant. In my years I’ve never seen an overall shortage of products like this. Specifically to oncology products, it’s very significant,” he said. He said Mercy has been fortunate to be able to meet the drug demands of its 1,200 cancer patients yearly.
Shortage is difficult
For Schwaninger, the volatile supply has resulted in her chemotherapy being postponed three times, including once this week. Her doctor, who has her on chemotherapy every 21 days, told her she’ll be fine if the drug arrives as expected next week. If not, she’ll need to begin an alternative drug. That’s not a simple proposition.
Pharmacist Erin Fox oversees a shortage- tracking program at the University of Utah. “That’s what makes a chemo shortage very difficult. These aren’t easy drugs to switch out like Legos,” she said.
Quality and manufacturing issues are the major reasons behind the shortages, according to the Food and Drug Administration. Other reasons include raw material supply problems, increased demand, limited number of manufacturers for some drugs and drug companies’ decisions to stop manufacturing older drugs in favor of newer, more profitable drugs.
Already this year, 180 different medicines are unavailable for diseases ranging from cancer to bacterial infections to central nervous system diseases, the program shows. A record 211 medications were unavailable last year.
There are about 300 different kinds of cancer, each treated differently, though there are generally three or four different therapies to treat a cancer, Pant said.
A drug called 5 fluorouracil is a mainstay oncology drug used since the 1960s to treat pancreatic, colon and related cancers. Pant said he doesn’t think there’s ever been a shortage of the drug until about two weeks ago. Now, instead of using it in patients’ IV, the center has to substitute an older drug used at a different interval than the 5 fluorouracil.
Earlier this year, the nation dealt with a critical shortage of cytarabine, used against cancers of the blood.
“That had us scrambling,” Pant said. “Thankfully that shortage is gone because that is an essential, essential drug for” leukemia patients.
There were a few substitutions available so patients could wait out the shortage; otherwise he said it would have been a big problem.
Many health care providers are now working to find Doxil and Taxol, drugs used to treat ovarian cancer like Schwaninger has.
Fox said Doxil is hardest to find. The manufacturer began asking on Aug. 5 that hospitals and clinics fill out paperwork on behalf of their patients in hopes of getting some of the dwindling supply. She said the cancer hospital still hadn’t received any last time she checked, and no one’s sure whether the drug will be sent on the basis of each patient’s story or first-come, first-served or other criteria.
Schwaninger said she trusts her doctor and is fine with a change, if needed.
What’s being done
Her husband of 62 years, Bob Schwaninger, 85, isn’t quite as patient.
“Being this is my wife, I get all upset. I understand. Yet it’s my wife that’s not getting treatment,” he said.
“He thinks he can’t live without me,” Dorothy Schwaninger said.
“I can’t,” he said.
The FDA is holding a public meeting in Maryland on Sept. 26 to seek possible solutions to the drug problem.
Also, two congressional bills are aimed at improving communications to help address the scarcity.
And related drug issues plague doctors.
A September study by the Institute for Safe Medication Practices indicated two deaths in patients related to an accidental overdose of a pain medication substituted when morphine, a drug often prescribed to cancer patients was unavailable. Mike Cohen said he confirmed 15 Alabama patients developed blood infections, ending in nine deaths from contamination of a substituted powder form of a nutritional solution commonly used by cancer patients.
“I firmly believe with all these drug shortages, we have a health crisis on our hands in our country,” Erin Fox said.