Chicago-area hospitals are struggling with a nationwide shortage of cancer medications, leading local doctors to sometimes ration the life-saving drugs.
Two of the drugs in short supply are carboplatin and cisplatin. The medications are often used together to treat a range of cancers, including lung, breast, and prostate cancers, as well as many leukemias and lymphomas.
At Cook County Health, doctors are changing the medication regimens of about 30% of patients because of the shortages, Dr. Urjeet Patel, interim medical director of the cancer center at Cook County Health, said at a news conference Friday. Doctors must give some of those patients less established or inferior medications, he said.
“We at Cook County Health are finding we do not have access to the critical drugs we need to take care of our patients,” Patel said. “It’s too soon to know what the full ramifications of this will be, but if the shortages continue we expect to see worse outcomes, longer durations of treatment, worse side effects, likely increased risk of cancer recurrence and even death.”
University of Chicago Medicine is also using alternative medications, when appropriate, the health system said in a statement Friday. The system is working with medical ethicists “to prioritize patients equitably and ethically,” according to the statement.
At Rush University Medical Center, doctors are reserving cisplatin for patients who can be cured by the drug, said Dr. Alan Tan, director of genitourinary oncology at the hospital. Cisplatin can often be used to cure certain cancers, such as bladder and testicular cancer, when used with other medications.
Patients who can’t be cured by cisplatin are getting carboplatin instead. Tan said it’s not causing a problem with care at the moment, but if cisplatin runs so low that it can’t be given to curable patients, that would be a big concern.
“If we don’t have access to cisplatin, a highly curable cancer can turn into something that is fatal,” Tan said.
Cancer centers across the country are grappling with the shortages. The National Comprehensive Cancer Network surveyed 27 cancer centers across the country late last month, and found that 93% were experiencing a shortage of carboplatin, and 70% a shortage of cisplatin.
The drugs are in short supply because of manufacturing delays and increased demand, according to the American Society of Health-System Pharmacists. The society first reported the shortage of carboplatin in late March and a shortage of cisplatin in January.
The problem is that one company made about half of the cisplatin used in the U.S., and an inspection late last year uncovered quality problems at the company’s plant in India that produced the drug, said Erin Fox, associate chief pharmacy officer for shared services at University of Utah Health. That plant had to pause production.
Carboplatin is now in short supply as well largely because it’s a substitute for cisplatin, Fox said.
“The main concern is if other companies can’t ramp up production enough we might see this shortage last for months, and if that happens more rationing of care will have to happen,” Fox said.
U.S. Sen. Dick Durbin said Friday at the news conference that, already, “providers are having to ration care only for the sickest of patients.”
He read a letter from a constituent who said her mother-in-law has stage 4 cancer, but her doctor can’t find carboplatin. She wrote that it’s “the one thing that has the potential to save her life at this point.”
“She’s in a holding pattern,” the constituent wrote. “We’re not ready to lose her.”
Durbin said, “Receiving a cancer diagnosis and being told there’s a drug that can save you but they can’t get their hands on it because of shortage is simply unacceptable in America.”
The U.S. Food and Drug Administration recently decided to temporarily allow the importation of cisplatin made in China, in an attempt to ease the shortage. And it is allowing some shipments from the plant in India of cisplatin and carboplatin that have been subjected to extra testing.
The shortages are the latest in a series of medication shortfalls in recent years. Hundreds of medications have recently been in short supply in the U.S., including Adderall, which is used to treat ADHD. Over the winter, parents struggled to find children’s Tylenol and similar medications.
In April, two University of Chicago Medicine doctors wrote an article advocating for the U.S. to set up a stockpile of generic cancer drugs to help address future shortages — an idea that Durbin said Friday the U.S. should consider.
