PLYMOUTH MEETING, PA — Every cancer center responding to a National Comprehensive Cancer Network survey reported at least one anti-cancer drug shortage in late August, extending a supply problem that has persisted for more than three years and is forcing providers to devote additional resources to maintaining treatment schedules.
More than 20% of responding centers reported shortages involving at least five medications, according to the Plymouth Meeting-based alliance of cancer centers.
Ifosfamide was the most widely affected drug, with 94% of respondents reporting a shortage. The generic chemotherapy is used to treat cancers including bladder, ovarian, testicular and uterine cancers, sarcomas, and several adult and pediatric leukemias and lymphomas.
Carboplatin shortages, which helped prompt NCCN to begin surveying its member institutions about drug supplies in June 2023, were reported by 71% of responding centers. Another 16% reported shortages of cisplatin.
More than half reported shortages of Bacillus Calmette-Guérin, or BCG, an immunotherapy used for bladder cancer.
The supply constraints are adding administrative and operational costs to cancer care. Sixty-one percent of responding centers said pharmacy- and physician-led mitigation strategies were required to keep all patients on recommended doses and schedules.
Most used waste-management strategies, while others considered alternative recommended treatment regimens.
When treatment plans required modification, 90% of centers reported needing to obtain repeat prior authorization, increasing the administrative work associated with individual patients and creating the potential for delays in continuity of care.
NCCN Chief Executive Officer Crystal S. Denlinger said cancer centers have developed internal strategies, task forces and communication plans to keep patient care and clinical trials operating during shortages.
“The bad news is that this takes time and attention that could be better spent on improving patient experiences and outcomes and adds additional stress to an already burdened system,” Denlinger said.
The survey also points to little perceived improvement from government efforts since NCCN began tracking the shortages. Asked whether national or state policies had made drug shortages better or worse since 2023, 4% of pharmacy directors said conditions had improved, while 96% said they remained the same.
NCCN said nearly every pharmacy director responding to the survey favored economic incentives aimed at encouraging high-quality manufacturing of generic cancer medications.
“Many oncology generics are clinically indispensable but economically unattractive,” one survey respondent said. “Without correcting that economic imbalance, shortages are likely to recur.”
Respondents also sought more information about generic-drug suppliers and earlier manufacturer notifications to the U.S. Food and Drug Administration about potential supply disruptions.
The findings were based on responses from pharmacy directors and other clinical and administrative leaders at NCCN member institutions in late August.
NCCN is part of the End Cancer Drug Shortages Coalition, a group of more than a dozen hematology and oncology nonprofits. The coalition issued a consensus statement in May outlining policy proposals aimed at addressing persistent shortages.
Current and previous NCCN survey results are available at NCCN.org/drug-shortages.
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