In the face of an unprecedented drug shortage, HOPA partnered with ACCC and AVAHO to lead a virtual round table discussing best practices the multidisciplinary cancer care team can use to mitigate its effects.
This is the second ACCCBuzz post reporting on Critical Conversations: Navigating Drug Shortages and Empowering Oncology Pharmacists, a virtual webinar held by HOPA in partnership with ACCC and AVAHO. Read the first onehere.
In a recent report, the US Senate Committee on Homeland Security and Governmental Affairs found that the average drug shortage in the United States lasts approximately 1.5 years. The report also found that between 2021 and 2022, drug shortages increased by approximately 30%. Should that trend continue, cancer programs and practices in the US must develop strategies to ensure they are prepared to handle future drug shortages. Understanding this need, panelists on Critical Conversations: Navigating Drug Shortages and Empowering Oncology Pharmacists, a webinar hosted by Hematology/Oncology Pharmacy Association (HOPA) in partnership with Association of Cancer Care Centers (ACCC) and Association of VA Hematology/Oncology (AVAHO) discussed best practices for managing drug shortages.
“They [cisplatin and carboplatin] will come under shortage several times either within the same year, or the future,” said Jeffrey Pilz PharmD, MPA, MS, BCPS, assistant director of pharmacy-medication safety and drug policy at The Ohio State University Wexner Medical Center. “If you have a good process or foundation on how to manage any drug shortage, it will make it a little bit less painful.” According to Dr Pilz, part of that foundation is having a group of individuals that can effectively address any drug shortage that may arise. “Here at [The] Ohio State [University Wexner Medical Center], we have a drug shortage committee which is a multidisciplinary group that can collaborate and make decisions on the spot,” Dr Pilz explained.
Dr Pilz believes that although this technique has worked for The Ohio State University Wexner Medical Center, when dealing with drug shortages, there is not a one-size-fits-all solution. Mahta Mahmoudieh, PharmD, hematology/oncology pharmacy clinical specialist at Inova Schar Cancer Institute-Fair Oak presented a different approach. “[Drug] shortage cases where I have been most successful at being proactive, have been where I have been empowered as a clinical specialist to have a close relationship with our buyers, and to be able to perform basic informatic pharmacy duties, such as pulling my own reports,” she said. Natalie Osagie, PharmD, BCPS, BCOP, clinical pharmacy specialist hematology/oncology at AVAHOshared a similar sentiment.
“We have a drug inventory which certain people have access to, and the buyer is expected to keep a certain stock. If you have one in your facility, you should keep tabs on it,” Dr Osagie said. Dr Pilz advises healthcare organizations with a similar infrastructure to include safeguards that alert providers when a specific drug is in short supply. “We can flag for certain items, especially the ones we know undergo chronic shortage—we can be flagged before we hit that minimum [number], and determine if there is a shortage,” he said.
According to Peter Stuessy, PharmD, clinical pharmacy specialist, oncology, at Advocate Health Midwest, strategies that empower the oncology pharmacist are vital due to a lack of transparency from drug manufacturers. “When a manufacturer is having supply issues, they don’t like telling everyone that—it is bad for their business,” Dr Stuessy explained. “Often, we get hints and ideas from other people we know around the country about any challenges that may be on the horizon.”
The gaps in care created by the shortage of cisplatin and carboplatin have forced cancer care providers to use alternative agents in treating patients. “In my facility we went back to the drawing board and looked for medications that may not be a platinum agent but are feasible for us to use,” Dr Osagie said. “It hasn’t been feasible for patients with non-metastatic lung cancer, so we are having to prioritize medication for those patients, but for the metastatic setting, we have been able to come up with some options.”
Building on Dr Osagie’s thoughts, Sarah Hayward, PharmD, clinical pharmacy specialist at Stephenson Cancer Center, University of Oklahoma, shared her perspective. “In some of the disease sites such as in gynecological and lung [cancer], the data continues to point where platinum-based therapies in certain situations are with curative intent, and we don’t have a lot of other options,” Dr Hayward said.
Alternative agents and planning committees can only do so much to prevent future shortages. Should the current problems in the US drug manufacturing supply chain persist, healthcare organizations may find themselves in an incessant game of musical chairs—forced to use band aids to patch a leaking dam. However, policy initiatives may provide a permanent solution. “COVID-19 brought the market chain and drug shortage issues to light, and there were some great efforts by Congress within the Mitigation Emergency Drug Shortages Act that was within the CARES Act, but there is an opportunity to do more,” said Sarah Hudson-DiSalle, PharmD, RPh, pharmacy manager of Medication Assistance and Reimbursement Services at the Arthur G. James Cancer Hospital and Richard J. Solove Research Institute at The Ohio State University. “We can make some regulatory and marketplace changes, as we partner with our manufacturers, our wholesalers, and legislative folks, as well as the FDA [US Food and Drug Administration],” she concluded.
“ACCC is working with its members, as well as other provider and patient advocacy organizations, to monitor the drug shortage situation and identify potential policy solutions,” said Nicole Tapay, JD, director, cancer care delivery & health policy at ACCC.
“The recent shortages in cisplatin and carboplatin were exacerbated by overseas plant closures by the FDA [US Food and Drug Administration]. We could have better anticipated and taken steps to mitigate the problem before it became a full-blown crisis,” said Olalekan Ajayi, PharmD, MBA, chief operating officer at Highlands Oncology Group, PA, and ACCC 2023-2024 president. “I think setting up better surveillance systems is critical to preventing drug shortages in the future. We must also provide more timely resources to the multidisciplinary cancer care teams on better inventory management and best practices to manage drug shortages. ACCC continues to be the leading resource in this regard. We all have a responsibility and a role to play in solving the drug shortage problem. We must all fight to protect our patients."
"An ACCC member program recently shared how drug shortages were essentially forcing oncologists to ‘prioritize’ patients receiving curative treatment over those receiving palliative care,” said Leigh Boehmer, PharmD, BCOP, chief medical officer and deputy executive director at ACCC. “That is not a decision any cancer care provider wants to—or should need to—make.”
