Here’s How One Cancer Center Is Handling the Chemo Shortage

An ongoing shortage of platinum-based chemotherapy drugs (cisplatin and carboplatin) is forcing some doctors to make difficult decisions regarding the cancer regimens they are prescribing their patients.

Experts say that the chemotherapy shortage may last for months to come, while others mentioned that facing the shortage will require a holistic approach. At the University of Wisconsin-Madison School of Medicine and Public Health, doctors are considering the goal or intent of treatment for each patient, while also considering how many patients need these drugs, and the supply of them that is available, explained Dr. Hamid Emamekhoo, medical oncologist with a clinical and research focus on genitourinary malignancies.

Transcription

In the short term, we have tried to figure out how are we going to strategize? Multiple factors are in place. So what we did at our institution, for example, was very quickly we put together a committee in a group that was evaluating the situation: what is the extent of the shortage how much of cisplatin and carboplatin do we have at hand? How many patients do we have on these treatments? How long can we continue providing treatments to these patients? And how are we going to try to obtain more carboplatin and cisplatin from different resources that our oncology pharmacy was trying to get? I think it wasn't specifically for just the GU cancers because we had to consider all different diseases that are treated with platinum agents.

So many things should be considered in that decision making and how can we extend the time that we can continue treating patients with these agents at the time of this shortage. So many, many factors come into place.

We have to think about the treatment goal and the intent of treatment. Is it curative intent treatment, are we using it for the neoadjuvant or adjuvant settings? Or is this for life-extending treatment in the palliative setting, for example, palliative intent in the metastatic disease setting, how much of an impact this treatment has on the patient's survival? Is it a patient who has had a treatment before and had some progression? Or platinum-refractory disease per se, and we are trying to retreat them or not?

We brought all of these decisions into all these factors into our decision-making process. So we communicated with our teams, with our providers with everyone who is involved very clearly tried to help them with some even guidance about how to make decisions about which patients could be treated with alternative treatment approaches. So are there any alternative regimens that could be used and have similar — or maybe even better — efficacy in the setting. We decided to see how many of these patients have to get this treatment, which ones are in the curative setting, how many of them might have an alternative regimen that could be considered in this situation, and then created a list of patients that are on these treatments, communicated directly with each and every one of the providers, ask them to review the cases and see if they can make some adjustments or change the treatment plan to another alternative regimen, if possible, and then provide some even talking points for the providers.

These are very tough discussions, and it's a hard decision to make; it's tough and hard communication with the patient. So, we try to make it as smooth as possible, provided some talking points, some support for the providers, if they are feeling that “OK, I this is a hard situation or condition and discussion, I need some support from the leadership, that the team was always happy and available to help with those situations, too.”

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