Most U.S. residents are unaware there are shortages in the availability of cancer drugs, such as those for multiple myeloma, a type of cancer that starts in the bone marrow.
In addition, even though non-cancer patients were unaware of the shortage, most said they would want to know if a substitute therapy had to be used in their care during a shortage. In fact, a significant percentage of respondents would prefer to transfer care to avoid a substitution if the alternate therapy had major differences from the preferred therapy.
The findings from this survey were published under the title “Cancer Drug Shortages: Awareness and Perspectives From a Representative Sample of the US Population” in CANCER, the peer-reviewed journal of the American Cancer Society (ACS).
Drug shortages could impact patient care, raise costs and hamper clinical trials. However, little research has been done about how patients might approach such an event.
To investigate, a 13-item survey was given to 420 respondents representative of the U.S. population with respect to age, gender, race and ethnicity, geography, education, and income.
“It can be stressful for patients with cancer to learn that their care may be impacted by drug shortages, but it’s important for oncologists to engage patients in these discussions,” Zachary A. K. Frosch, MD, lead author of the study, said in a press release. “Our data suggest that people expect disclosure of shortages as part of the caregiving process.”
Understandably, respondents with a personal history of cancer were more likely to be aware of the latest events (31% versus 14%).
Most survey respondents reported that if they were patients, they would want to be informed about a substitution due to a shortage: 87% and 82% for major or minor differences in effectiveness, and 87% and 83% for major or minor differences in side effects. Most also reported they would transfer care to avoid a substitution with major differences from the preferred therapy:
To avoid a substitution with major differences from the preferred cancer therapy, most people also said they would prefer to transfer care — 72% would transfer care for major differences in effectiveness and 61% would do so for major differences in side effects.
However, African-American respondents, uninsured patients, unemployed people, those with lower incomes and those with less education all were less likely to report that they would transfer care to avoid differences in effectiveness.
Findings from this study raise the concern that disclosure regarding cancer drug shortages actually could exacerbate care disparities, specifically because of what this group reported. In addition, black, uninsured and unemployed individuals said they were less likely to use publicly reported shortage data in deciding where to seek treatment.
Awareness of cancer drug shortages, however, potentially could increase pressure to solve the system-wide problems that lead to shortages, Frosch emphasized.
“It’s important that everyone — clinicians, patients, and the public — have a seat at the table as these strategies are developed,” he said.
In conclusion, this study suggests that most U.S. citizens are unaware of national cancer drug shortages and, when faced with even minor consequences from drug substitutions, they would want to know about the change. In addition, when the differences between the preferred and substitute cancer therapies are great, many reported they would transfer their care to continue receiving the preferred regimen.
In alignment with other studies, traditionally vulnerable populations were found to be less likely to report they would transfer their care to avoid the negative impact of substitutions, suggesting that care shortages may represent a new source of health-related disparities in the near future.