Posted on 07/09/2023 2:08:39 PM PDT by nickcarraway
"We are running low on cisplatin."
"The e-mail came. We are out of carboplatin."
"How do I prioritize which patients can receive the chemotherapy drugs?"
"I can't give my patients the life-saving chemotherapy that they need."
These are comments that have been shared in the media by oncologists throughout the country as a response to the chemotherapy drug shortages that started earlier this year. While drug shortages do happen often, the extent of this chemotherapy shortage appears unprecedented as it may be impacting as many as 500,000 Americansopens in a new tab or window.
As an oncologist, I aim to be honest and transparent with my patients about their diagnosis and treatment options. I strive to be realistic about their prognosis and the side effects they may experience. Initially, the shortages seemed to be far away and were not directly impacting patient care in the clinic. At the time, there was little media coverage and many patients were unaware of what was going on. All that quickly changed as I soon found myself sitting across the room from patients and their families, telling them I could not guarantee they would receive their next chemotherapy on time, if at all.
I have been asked to describe what those conversations are like. In one word, they are devastating. These are people facing a life-changing diagnosis who are often still trying to process what all of this means. In that moment when they are told, "There is treatment available but I do not know if and when you can receive it," the glimmers of hope and possibility quickly fade. Having a clear treatment plan is very powerful and motivating for people, but the fear of the uncertain and unknown is often terrifying.
The shortages have become prevalent throughout the country. A National Comprehensive Cancer Network (NCCN) surveyopens in a new tab or window showed that 93% of surveyed cancer centers were experiencing a shortage of carboplatin and 70% of the centers were experiencing a cisplatin shortage. As a result, oncologists have had to make very challenging decisions about chemotherapy utilization and prioritization. The American Society of Clinical Oncologyopens in a new tab or window (ASCO) and the Society of Gynecologic Oncologyopens in a new tab or window (SGO) have issued excellent clinical guidance for physicians to aid in making treatment decisions. Yet, even exemplary guidance won't solve the shortages. One of the recommendations is to reprioritize the non-essential use of any antineoplastic medication that is in short supply and to encourage use of an alternative agent or intervention with comparable safety and efficacy, if available. While this is possible for some cancer types, it is not possible for all, and substitutions in treatment plans often come with unknowns in terms of dosing, efficacy, and the potential of increased toxicity. Clinicians are being forced to reconsider entire treatment plans and patients are left frantically wondering how this will impact them in the long run. Unfortunately, the truth is we just don't know.
The ethical dilemmas posed by these shortages are quite pronounced. In situations of limited supply, oncologists and cancer centers have been forced to make decisions about which patients to prioritize. For example, in the absence of effective alternatives, who receives the infusion of carboplatin that day? Is it the mother of three young kids with platinum-sensitive recurrent ovarian cancer or the grandmother with a newly diagnosed, locally advanced but curable uterine cancer? Both patients desperately need the medication and yet, physicians have had to choose. In a time where physician burnout is already through the roof, the moral injury created by these shortages is inevitably contributing to the ongoing problems. Not being able to deliver the care and treatment we want to provide, and that patients deserve, is truly harrowing.
As time has gone by, the reason for the shortages has become clear. The shutdown at a pharmaceutical company due to quality issuesopens in a new tab or window compounded with the inability by other pharmaceutical companies to respond to the increased demand has resulted in the current situation. There have been some short-term solutions put into place to increase production but whether they will have significant impact in terms of what our patients need remains to be seen. What is clear is that carboplatin and cisplatin will not be the only chemotherapy drug shortages we deal with. The loss of profit from the generic drug market in the U.S. is causing companies to decrease or stop drug production, transition their production to overseas (where FDA inspections are less likely), and invest less resources in upgrading factories and focusing on quality. There is a desperate need for incentives to increase generic drug production and to create contingency plans to preempt potential future shortages. These changes will not happen overnight and require continued advocacy and lobbying.
In early June 2023, over 40,000 members of the cancer community -- including oncologists, researchers, patient advocates, healthcare professionals, members from industry, and more -- gathered in Chicago at the 2023 ASCO Annual Meeting. Groundbreaking research with novel treatments was presented. However, the irony of the situation was not lost on me: we relished in being at the world's largest oncology stage, while patients back in cancer centers throughout the country anxiously awaited to hear whether the shipment of carboplatin or cisplatin would arrive that week. We speak of the Cancer Moonshot and its goal to reduce the cancer death rate by half in the next 25 yearsopens in a new tab or window, but how can we do that if we lack the means to provide life-saving generic chemotherapy drugs to patients? The COVID-19 pandemic emphasized how postponing cancer treatment leads to worse outcomes. This is not the time to re-visit this lesson again.
#WeNeedChemoDrugs. I urge you to continue to advocate for our patients and the cancer community as a whole. Until we have long-term solutions, it is only a matter of time before the next e-mail with the next drug shortage arrives.
Eleonora Teplinsky, MD,opens in a new tab or window is head of Breast and Gynecologic Medical Oncology for Valley-Mount Sinai Comprehensive Cancer Care in Paramus, New Jersey. She is a member of the ASCO Advisory Group for the drug shortages.
Interesting, I wonder what has caused the increased demand?
Oh, and the pharm company being shut down for quality issues. That is interesting too. That’s what caused the baby food shortage, right?
Quality issues at a pharm company... huh.... didn’t interfere one bit with the “vax” production when they had QC issues.
Simple, you prioritize patients who Virtue Signal unequivocal Vocal support for Children's Sex "Reassignment" Surgery directed by Public School "Counselors", Tran-sexual Persons, Homosexuals by Birth, Endorse an Infinite number of "Genders", and Reparations for everyone NOT White.
Which is unchanged fro your current policy.
There's a rare talent...
The answer is that docs are diluting their standard doses. A 10-15% reduction for a few rounds is not going to make a significant difference.
At least that is what the head of our Oconcolgy Department explained last week.
In some cases, it's from people who weren't going to the doctor during lockdown.
“These are comments that have been shared in the media by oncologists throughout the country as a response to the chemotherapy drug shortages that started earlier this year.”
Oh, just ignore what’s going on with our drug (and related) situation, due to goading China on Taiwan. Everything will be fine, what really matters is UKRAINE!!!, UKRAINE!!!, UKRAINE!!!.
After all, do we really need pharmaceuticals, really?
Let me guess. “PUTIN’S chemotherapy drug shortage.”
Well... I suppose, but I’m still suspicious.
Like most things, it is likely due to a combination of variables.
A combination in which several of the factors shouldn’t be happening. But they are because the leftists in power have maliciously gummed things up.
I’ve told people for years, if you have a medication that you can’t do without, stockpile it if you can. I quit telling my BIL and his commie wife. They run out, it’s their problem. My wife and I have ceased to care what happens to them if things get really bad.
I haven’t forgotten what happened in Greece, but apparently most people in the USA have.
I keep a 15-18 month supply of my heart meds (only one drug thankfully). If I see things going sideways I’ll immediately get it up to 24 months.
Miggies are coming to America for their healthcare because it’s “free”. All of us Americans are going to be ****ed pretty soon. Meds are going to skyrocket and be harder than hell to get. Don’t forget to ask for some more chips and salsa.
My German Shepherd mix went to an oncology center a little over a year ago. Got 8 months of chemo for lymphoma and total cost, no insurance, was 8,000 bucks. Gave her another 18 months of great quality of life. Lost her to old age at almost 15. But she was there at my wedding in great health. Got a few last Bonanza airplane rides and one more tomahawk steak with a footlong bone.
But I wondered what that same chemo would have cost a human.
A medical friend of mine saw the protocol they gave her and shook his head. Said it was straight up standard things they would use.
Interesting, on dogs it doesn’t hit them the way it does people with the side effects.
I’ve been told that, because I am on palliative care, I no longer qualify to receive carboplatin.
I was under the understanding that you had to agree to palliative care. I know it doesn’t always quite go according to the rules though. Especially these days.
i’ve been under going BCG immunology treatment for bladder cancer and was just taken off of it do to “shortage” i suspect our drugs are again coming from china. I sure wish this country didn’vote against capitolism, Trump, and for communism, Biden and democratic party. We would be far better off today with Trump.
A government does not maintain an expense unless there is value in its continuance.
Elections have consequences.
My bet is bill gates or some other depopulation ghoul is behind this.
It’s not just chemo drugs. It’s frickin’ everything. Antibiotics, antivirals, antiemetics (specifically Zofran ODT), Adderall and similar drugs (for fatties to lose weight; it’s basically legal meth in a pill), Ozempic and similar pen injectors (again, fat people wanting a magic pill), analgesics like Fentanyl, Potassium (20meq), and stuff I can’t immediately recall.
My bosses have never seen it like this before.
If the doctors get desperate will they start using inexpensive and nontoxic treatments like IP6, curcumin, and vitamin C?
No, they would rather let their patients die than do that. And in some states they might even be prosecuted and lose their licenses for saving lives that way.
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