How drug shortages could affect the future of cancer care

2012-02-04 13:48
Cancer drugs that are in short supply could have grave consequences.

A recent survey shows oncologists and patients are facing a dilemma in cancer treatment. Drug shortages, combined with high cost of chemotherapy, were found in an independent analysis to have dire consequences for 73 percent of cancer patients who can't afford co-payments. The result is that cancer patients are dying sooner and some oncologists are sensing a bleak professional future.

The survey, conducted by the National Analysts Worldwide, confirms "...some of our worst fears," says Susan Schwartz McDonald, President and CEO of National Analysts Worldwide and a lead researcher on the survey. "At a time when important advances promise new hope in many forms of cancer, chronic drug shortages and reduced access to care threaten to undermine our ability to combat disease."

Dr. David Loeb, a pediatric oncologist, recently published concerns about cancer drug shortages. According to Loeb, reasons oncology drugs are in short supply are complex.

He explains, “Briefly, the problem can be traced, in part, to a rule by The Centers for Medicare and Medicaid Services (CMS) called the ASP + 6 Rule. This rule limits what a private oncologist can charge for a chemotherapy drug to the Average Sale Price plus 6%.”

Older cancer drugs are available in generic, and remain inexpensive.

“A vial of carboplatin once sold for $125, but recently the cost has fallen to $3.50. Add 6% to that, and you certainly don't recoup the cost of administering the drug in your office”, Loeb writes.

Consequently, there is no incentive for drug companies to manufacture generic – and less expensive – cancer drugs, which would help underinsured and uninsured cancer patients. But even if they did, there isn’t any financial incentive for oncologists to use the drugs.

Non-generic cancer drugs are also in short supply because fewer plants manufacture the chemotherapy agents.

Loeb says “There is currently a nationwide shortage of Doxil (liposomal doxorubicin), which is not a generic.” The manufacturing plant was shut down due to quality control issues. As a result research is affected. Oncologists are forced to use drugs they’re not familiar with, which can lead to mistakes that also have dire consequences for cancer patients.

The National Analysts Worldwide survey polled 204 U.S. oncologists.

  • Sixty-five percent said they see a shortage of oncologists on the horizon.
  • Seventy-one percent said cancer drug shortages mean a less satisfying future, personally and professionally.
  • Forty-eight percent of oncologists said they are seeing patients die sooner, and 50 percent predict an upward trend in early cancer deaths in the next year.
  • Eighty-five percent said they have had patients receiving less than optimal treatment.
  • Nearly all U.S. oncologists have had patients who were unable to receive timely treatment due to drug shortages in the past year; just14% said they think the situation will improve.
  • Cancer patients are receiving less that optimal care because they can’t afford their co-payments said 73% of US oncologists.
  • Seventy-nine percent of cancer doctors said not having health insurance means patients won't get the best treatment available, despite the fact that 80% are optimistic about new discoveries to improve and quality of life for patients.
  • Even so, 70% of oncologists doubt that patients or society can handle the cost of new cancer treatments.

The survey confirms patients are dying sooner from a shortage of cancer drugs. Short supplies, combined with high cost, and CMS rules for reimbursement could have grave consequences for the future of cancer care. Sadly, forty-eight percent of oncologists responding to the survey said they saw their patient’s tumors return and 40% see cancer patients dying sooner.

Resources:
National Analysts Worldwide
"A Survey of Battlefields in the War on Cancer: Oncologists Reporting from the Front Lines"
1/31/2012

Dr. David's Blog
"Yes, we have no - Zofran?"
David Loeb, MD
1/22/2012

Image credit: Wikimedia commons

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