Purpose: This study assessed how directors of clinical pharmacy and physicians negotiate shortages of injectable oncology drugs and the impact of their decisions on patient care.
Methods: An online survey was sent to 1334 members of the American Society of Health-System Pharmacists identified as directors of pharmacy. Survey recipients were asked to report the extent to which their facilities were affected by injectable oncology drug shortages, ways in which providers changed treatments in response to shortages, impact on patient safety and outcomes, strategies used to minimize these impacts, and effects on cost, patient safety and outcomes as a result of these strategies.
Results: 358 (27%) respondents completed the survey. 98% of respondents reported experiencing at least one drug shortage during the last 12months, with 70% reporting inadequate supply to treat patients and 63% reporting completely running out of at least one injectable oncology drug.
62% of respondents reported using alternative drug regimens, 46% reported changing dosage during treatment, 43% reported delaying treatment, 38% reported providers prioritizing patients for treatment based on clinical factors and 21% reported that patients were referred to, or accepted from, other facilities to receive treatment. The majority of respondents reported communicating information about shortages to personnel (96%), increasing inventory of drugs at risk of shortage (76%), devoting increased staff time to managing drug shortages (71%), implementing strategies to reduce drug waste (66%), proactively identifying alternatives and substitution protocols (65%) and increasing communication with manufacturers and distributers. All of these strategies reportedly increased costs.
24% of respondents reported safety events resulting from injectable oncology drug shortages. Administering an incorrect dosage or substitute, adverse reactions to substitutes, avoidable events due to treatment delay or alteration and disease progression were the primary risks associated with shortages. Only 40% of respondents agreed that information currently available regarding shortages is useful in mitigating shortage effects. 62% disagreed that information was timely, 54% disagreed that it was comprehensive and 61% disagreed that it was reliable.
Conclusion: Shortages of injectable oncology drugs appear to be widespread and to be having a significant impact on patient care, based on a nationwide survey of directors of clinical pharmacy. Current information does not meet administrative or clinical needs.