Opinion: We Need to Advocate for Patients During the Chemotherapy Shortage

Debi Fischer, MSW, BSN, BA, LCSW, RN

Carboplatin and cisplatin are in shorter supply than normal. It has been reported that this chemotherapy shortage began when 1 manufacturing facility began to experience a quality issue. Because only 5 manufacturers produce these drugs, the quality issue started a ripple effect. Carboplatin contains platinum that prevents the progress of cancer cells by harming their DNA. Cisplatin is an alkylating agent which halts cancer cells from dividing and renders them dead. These platinum-based therapies are used on various slow-growing cancers, including bladder, breast, cervical, lung, and head and neck cancers, as well as leukemias, lymphomas, sarcomas, and more.

Clinicians, RNs, and social workers all have their own perspectives on the shortage. However, a large part of the problem has to do with pharmacy. They are the ultimate gatekeepers in terms of solving this troubling problem. As 1 writer with Mesothelioma Hub states, “Pharmaceutical companies must invest in expanding their manufacturing facilities, increasing production lines, or collaborating with contract manufacturers.”1 When pharmaceutical companies rely on only a few facilities, they leave the market vulnerable to failures like these.

Can the FDA Help?

The FDA has expressed interest in remedying this situation. However, despite being part of the federal government, it cannot force a company to produce more chemotherapy. The agency is limited in what it can mandate and report in terms of supply and demand. However, according to Mesothelioma Hub, “Essential drugs like chemotherapy lack diversified supply chains, and even if multiple manufacturers exist, most facilities operate at full capacity, making it challenging to provide buffer stockpile supplies in case of manufacturing disruptions.”¹

To try to solve this problem, the FDA has announced that it will work with Qilu Pharmaceutical, a Chinese drug company, to bring cisplatin to the US.1 Also, Apotex, a drug company form Canada, will take over for distributing cisplatin in intravenous form.¹ These two solutions will aid oncology patients in addressing this dire problem.

Advocating for Patients

RNs and clinical social workers can advocate for their patients by discussing treatment options with their patient’s oncologists. A viable solution might exist in receiving targeted therapy and radiation while they are waiting for their chemo. Different chemotherapy combinations or timelines might have to be substituted if the patient’s current therapy is not available.

“A shortage may lead to delays in care, such as delays in starting treatment, or can interrupt a current treatment plan,” Manali I. Patel, MD, MPH, MS, and Ana Velázquez Mañana, MD, MSc, reported on Cancer.Net. “A different treatment may need to be given if the preferred drug is not available.”

A lengthier answer to this need might exist in the federal government. Congress needs to enact legislation targeting drug companies that produce chemotherapy to prevent these deficits in the number of drugs produced.² Nurses and social workers can contact their respective representatives to find out about the federal government’s plan to address this shortage. Nurses and social work lobbyists can be rallied via email to look into this grave need.

In terms of provider solutions, the RN and social worker should be aware that the physician can also contact the American Society of Clinical Oncology to give them direction as to which route to follow during this critical time. From a therapeutic standpoint, the clinicians can ask their patients if they would be interested in attending an oncology support group or get a referral to a therapist where they can address these issues.²

The Bottom Line

Lack of chemotherapy can cause setbacks in treatment or interruptions in care.The most important piece of the puzzle is not to lose valuable time. Time is cancer’s enemy. Clinicians working in the field should stay up to date regarding these potential life-changing situations.

References

1. May M. Is there a chemotherapy drug shortage? MesotheliomaHub.com July 18, 2023. Accessed September 5, 2023.
   https://www.mesotheliomahub.com/blog/chemotherapy-drug-shortages/
    
2. Patel MI, Velázquez Mañana A. What are drug shortages and how can they impact care for people with cancer? June 23, 2023. Accessed September 5, 2023. Cancer.Net Web site: https://www.cancer.net/blog/2023-06/what-are-drug-shortages-and-how-can-they-impact-care-people-with-cancer