On Jan. 29, the National Cancer Institute released guidelines on how to best allocate scarce chemotherapy drugs for childhood cancer patients. The institute notes three critical factors in determining the allocation of scarce life-saving drugs for children with cancer: "Curability, prognosis and the incremental importance of a particular drug to a given patient's outcome,” according to The Journal of the National Cancer Institute.
Mary Faith Marshall, a jointly-appointed professor in the Medical School and the Nursing School and director of the biomedical ethics program in the Medical School, says the guidelines for distributing these drugs are good to keep in mind at a general level. However, other considerations will come up when dealing with individuals, including the stage of cancer the patient is experiencing and what resources have already been extended to them.
“If it’s early on, you may be less likely to provide that child with a scarce drug because there may be other standards of care drugs that are available that could be equally or close to as effective,” Marshall said.
The day before the NCI guidelines were released, The New York Times released an article on drug shortages throughout the country with interviews from doctors at the Cleveland Clinic and Johns Hopkins, who reported shortages of a variety of drugs.
“We used to use sodium bicarbonate to reduce the temporary burning sensation caused by lidocaine, a local anesthetic,” Eric Swensen, Medical Center public information officer, said in an email. “However, the supply of sodium bicarbonate has become more limited and has other, more important patient care uses, so we no longer give it to patients receiving lidocaine.”
Swensen also said generic medications, especially generic injectable medications, have been in short supply in recent years.
Doug Paige, RPh, manager of operations at Martha Jefferson Hospital Pharmacy says while shortages for specialty drugs like chemotherapy drugs still pop-up, general drug shortages were more of a problem three to five years ago. Martha Jefferson, however, does not have pediatric oncology or open-heart surgery specialties, and therefore has not had to deal with shortages in those areas.
“What’s happened over the past three years or so is that pharmacies have become much better about forecasting these issues, because we’ve, as an industry, had to endure some shortages,” Paige said. “It’s been escalated to everyone’s radar.”
In addition, Paige said, as part of the Sentara Health System, Martha Jefferson is able to trade both drugs and information about how to deal with drug shortages with other area hospitals.
Swensen and Paige were both quick to point out when a specific drug is in short supply, it can be replaced with a comparable one. For example, a hospital may stock an anti-nausea medicine because it is cheaper — not necessarily a better drug — and use its competitors when it becomes scarce.
Overall, it is important for health providers to be transparent, both with individual patients and with the public at large, Marshall said.
“It’s part of a robust informed consent process, and so patients have the right to know,” Marshall said. “And I think also, because a large number of our healthcare resources are public resources, it helps to educate the public about the fact that there are finite resources in healthcare, and we have to make hard decisions about what is the most important and how we’re going to allocate things that are scarce.”
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