Impact of Drug Shortages on Cancer Care Delivery Within the National Cancer Institute Community Oncology Research Program

Abstract

Purpose: Drug shortages represent a challenge in oncology care, with potential repercussions including suboptimal treatment options, treatment delays, and medication errors. However, there is scant evidence on how drug shortages interrupt cancer care delivery (CCD) nationally and specifically across National Cancer Institute (NCI) Community Oncology Research Program (NCORP) community oncology practices.

Methods: Between December 2020 and July 2024, 96 NCORP community oncology practices were enrolled. NCORP practice study staff completed the Drug Shortage Baseline Survey and Pharmacy Baseline Survey. The primary outcome was proportion of practices seriously affected by drug shortages (ie, encountered CCD problems [change to less effective treatments, adoption of more toxic alternatives, treatment delays, or an increase in medication errors or near misses]) in the past 3 months. Secondary outcomes included CCD problems among practices (eg, ethical dilemmas) and strategies used by practices (eg, use of alternative drugs, stockpiling). Finally, we described differences between seriously affected and nonaffected practices.

Results: Nearly 54% of NCORP practices were seriously affected by drug shortages in the past 3 months, with 23 drugs (including carboplatin [24.7%], leucovorin [22.6%], and cisplatin [19.4%]). Seriously affected practices were more likely to report lack of suitable alternatives (34.7% v 13.6%), substantial resources spent (70.8% v 50.0%), and change to alternative administration (73.5% v 52.3%) and were less likely to hire staff to address shortages (16.3% v 36.4%). Strategies to address shortages included using alternative drugs (91.5%), stockpiling (87.2%), and developing action plans (84.0%). Most (50.5%) practices reported experiencing an ethical dilemma related to a drug shortage.

Conclusion: Drug shortages influenced CCD among NCORP practices. This study underscores the need for robust strategies and policies to mitigate these effects and enhance the resilience of oncology practices.