John: One of the hallmarks of
the pandemic has been shortages
of many essential products,
everything from diapers to
building materials to medicine.
One recent shortage has limited
the supply of two critical
cancer drugs.
>> Hospitals and cancer centers
are running out of two major
injectable cancer drugs.
A new survey of cancer centers
nationwide found 93% were
experiencing a shortage of the
drug and 70% shortage of the
other.
Earlier this week before a house
subcommittee, the American
society urged the federal
government to take action to
strengthen the drug supply
chain.
>> Shortages place providers in
a moral dilemma, prioritizing
drugs for those curable versus
those who are not.
Patients worry about whether
they will receive their next
treatment or if switching to
another will shorten their
lives.
>> Joining me is the head of
breast medical oncology in new
Jersey.
Thank you for joining us.
Tell us about how critical these
drugs are.
What sort of cancers are they
used to treat?
>> Thank you for having me.
We use them for a variety of
cancers in breast and
gynecological cancers, my area
of expertise.
We use them for the majority of
cases of all of our
gynecological cancer patients
and a large proportion of breast
cancer patients as well.
But they are used for other
cancer types such as lung
cancer, testicular cancer, and
gastrointestinal cancers,
just to name a few.
>> When did you start
experiencing shortages?
>> Several weeks ago, just like
all hospitals throughout the
country.
>> How does that change the
access you and your colleagues
have to the drugs?
>> It is challenging as an
oncologist.
Talking about shortages with
patients when they are already
facing a life-changing diagnosis
is really difficult.
Sitting in front of a patient
for me and my colleagues across
country and telling them we have
proven drugs that can work but
we are not sure when and if they
will be able to receive them.
It is an agonizing conversation
for both myself as an
oncologist, for other
oncologists, and for the patient
and their family.
>> Absolutely.
Tell me about how irreplaceable
these two drugs are.
Is it easy to come up with
substitutes that do the same
thing in some of these
treatments?
>> It is not that easy.
It is not as simple as switching
one drug for another.
In certain cases, there are
substitutions.
But we have to keep in mind when
you substitute for another drug,
there are other side effects.
We may be venturing into less
chartered territory in terms of
the evidence that exists.
It is not as simple as saying we
don't have these, let's use a
different drug.
>> I want to ask you as a doctor
and human being, what has that
been like for you?
>> It is really morally
challenging.
I think it is something we need
to talk about.
To be able to have to make
decisions about which patients
to treat and which ones to
postpone, how to try to make the
drugs last longer, is something
all oncologists are grappling
with right now.
It really is unprecedented for
us.
These shortages are nothing I
have ever seen in my career.
Many other oncologists say the
same.
>> What is your understanding of
why these shortages are
affecting these drugs in
particular?
>> I think there are a number of
factors.
A lot of it does come down to
supply and demand.
We have seen a number of these
issues since the pandemic.
A lot of it has to do with
manufacturing and availability.
We do need a bit more
transparency in terms of how we
assess and are made aware of
drug availability.
>> That is what I wanted to ask
you about next, the transparency
element.
There are a lot of different
elements involved.
You have the pharmaceutical
companies, manufacturers where
the ingredients are sourced, the
fda.
I'm curious as a practitioner,
what sort of transparency or
lack thereof have you been
experiencing from the various
entities?
>> I think it is hard to figure
out exactly what is going on.
At the beginning of the
shortages, we did not know.
We were not made aware of why
the shortages were happening,
when they would get better.
As the weeks have gone by, there
has been more information
provided about where the demand
has increased and where the
supply has been lacking.
But it is not entirely clear
when we will see this come back
to full production and full
availability.
>> The American society for
clinical oncology has made
several recommendations to avoid
these shortages in the future.
They include strengthening the
strategic national stockpile of
medicine and reducing reliance
on other countries for some of
these important ingredients that
go into the drugs.
What changes would you like to
see?
>> I agree with those
recommendations.
I feel we need to have both
short-term solutions for the
current shortage but long-term
solutions.
Right now, it is these two.
In a few months, it could be
different drugs.
We need to have a plan that
allows us to face it shortage
and hopefully prevent it from
happening but if it is there to
act quickly and probably to get
the drugs to the patients who
need them.
That could mean having a supply,
that could mean increasing
immediate production if needed.
There are a number of key
stakeholders involved.
>> Thank you so much for your
time.
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