Cancer patients confront widespread shortages of chemo drugs
Experts: Root of shortage crisis partly due to low profit margins for generic meds
Cancer patients and their doctors are grappling with a record-high shortage of effective chemotherapy, putting their treatment — and lives — at risk. “The majority are cheap, generic drugs that have been utilized in cancer medicine for decades,” says Satyajit Kosuri, clinical director of the stem cell transplant and cellular therapy program at the University of Chicago, who has experienced the consequences firsthand.
At the end of last year, there were 295 active medication shortages, ranging from antibiotics and anesthetics to cardiac mediations and chemotherapy drugs, according to a Homeland Security and Governmental Affairs report, a 30% increase since 2021. Chemotherapy drugs, particularly those used to treat kids’ cancers, are among those medications experiencing some of the most prolonged shortages, says Yoram Unguru, a pediatric hematologist-oncologist at the Children’s Hospital at Sinai and core faculty, Johns Hopkins Berman Institute of Bioethics.
“These are the backbones of curative regimes,” he says. “We don’t have alternatives — it’s not like I can substitute a particular scarce chemotherapy agent with another. This isn’t strep throat or some other infection where if I don’t have amoxicillin, I can swap it out for something that’s probably if not as good, almost as good.”
The root of the drug shortage crisis, most experts agree, is related to low profit margins on generic drugs, an overreliance on foreign manufacturing, increasing quality risks and brittle supply chains. “These drugs that are in short supply are not the blockbusters that pharmaceutical companies make big bucks from,” Unguru explains. “They’re older, generic injectable drugs that companies don’t get a huge profit on.”
As a result, few companies make them, and those that do make just enough to fill demand. If suddenly one of those companies decides to get out of the market, or there’s a production problem, or they have difficulty sourcing the raw ingredients — roughly 80% of which come from China and India — there will be a drug shortage.
Delays in treatment caused by shortages can have tragic consequences. One recent meta-analysis found that a fourweek treatment delay can be associated with increased sickness or mortality for more than 40% of common cancers, including bladder, breast, colon and lung cancer. A 2017 report in the World Journal of Clinical Oncology based on a survey of more than 190 pediatric hematologists-oncologists found nearly 65% of the doctors said they had patients whose care was affected by shortages.
Recently, Kosuri had to break the news to a 40-year-old patient with relapsed testicular cancer that his lifesaving stem cell transplant procedures would be significantly delayed because of a shortage of the drug carboplatin, a go-to chemotherapy medication used for stem cell transplants and for many types of cancers. More than 90% of people treated for testicular cancer survive the disease. “With this cancer, you can be on death’s door and still be cured,” Kosuri says. “But now we’re having to make decisions about stopping treatment or telling them listen, we may not be able to do this procedure for you because we don’t have the drugs.”
Kosuri says the shortages are affecting “the entire spectrum of patients and diseases,” including tumors, blood cancers, kids and adults. “It’s having a negative impact across the board.”
A shortage of the leukemia drug fludarabine left some patients with no other options to treat their cancers, Kosuri says, leading to discussions about hospice instead. “It’s horrendous. We have the meds that can cure you, but we can’t give them to you, sorry.” Unguru says one of his new patients is facing a similarly alarming scenario. “Two of the drugs that this kid needs as part of her regimen are on the shortage list,” he says. “This is a curable cancer in most cases, and now maybe it won’t be because we don’t have the drugs.”