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Many US adults unaware of cancer drug shortages

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April 9, 2018

The general U.S. population appeared unaware of drug shortages for cancer treatment, according to results of a cross-sectional survey of the U.S. population.

“These shortages affect not only cancer drugs such as chemotherapies, but also key supportive medications such as pain medication and IV fluids — both of which have recently been in shortage,” study authors Gregory A. Abel, MD, MPH, associate professor of medicine at Harvard Medical School and director of the older adult hematologic malignancy program at Dana-Farber Cancer Institute, and Zachary A.K. Frosch, MD, instructor in medicine at Harvard Medical School and physician in internal medicine at Dana Farber Cancer Institute, told HemOnc Today. “This is a problem that hasn’t gone away and many who are potentially affected aren’t aware.”

Drug shortages may impair care, raise health care costs and burden clinical trials. Previous studies have investigated oncologists’ views and how the economy is impacted by shortages. However, data on patient knowledge of drug shortages remains limited.

Researchers administered a 13-item survey to 420 individuals randomly selected from the GfK KnowledgePanel, an online sample that embodied the general adult population with regard to sex, age, ethnicity, education, geography and income.

The survey provided hypothetical situations that required a drug substitution. Each situation included a substitute drug that had either a major or minor difference in efficacy — a 15% decrease in how well it treated cancer vs. a 5% decrease — or major or minor difference in adverse events, or a 15% decreased risk for severe rash vs. 5% increased risk for mild rash.

Researchers used a five-point Likert scale to determine whether respondents wanted to be informed of the substitution and if they would transfer cancer care to another center if the original drug were available. Preferences for drug allocations in the setting of shortages also were assessed.

Survey results indicated 16% of respondents were aware of cancer drug shortages. Of these, 68% reported awareness from having watched news and 27% due to internet sources.

Individuals with a personal history of cancer (31% vs. 14%; P = .03), higher level of education (23% with a college degree vs. 10% who completed high school; P = .01) and more access to health information (23% with three or more sources vs. 7% with zero sources; P = .01) were more likely to be aware of drug shortages.

More respondents indicated they would probably or definitely want to be notified of the substitution if it were to have major (87%) or minor differences (82%) in efficacy and major (87%) or minor (83%) differences in adverse events.

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Seventy-two percent reported they would probably or definitely transfer care to avoid major differences in efficacy and 46% said so for minor differences. Sixty-one percent would probably or definitely transfer care for major differences in adverse events, and 40% would for minor differences.

Fifty-eight percent said publicly available drug shortage data would be a large factor in where they would want to be treated, whereas 32% reported it would be a small factor.

Respondents with a personal history of cancer were less likely to report a transfer of care to avoid minor differences in efficacy (23% vs. 47%; P = .02). Researchers observed no other differences between respondents with and without a personal history of cancer.

Individuals who were uninsured, unemployed or black were less likely to report they would transfer care for major differences in adverse events or efficacy, but not for minor differences.

Black (38% vs. 60% for whites vs. 64% for Hispanics; P = .05), uninsured (28% vs. 61% for insured P < .001) and unemployed (44% vs. 58% for employed vs. 69% for retired; P = .01) individuals appeared less likely to report drug shortage data as a significant factor when deciding where to pursue treatment.

“Most people are unaware of cancer drug shortages. Yet, at the same time, they would want to know about any drug substitutions that affect their cancer care,” Abel and Frosch said. “Having these conversations around shortages can be difficult and complex, but our study suggests that they are discussions people want to have with their physicians if they were to be diagnosed with cancer.” – by Melinda Stevens

For more information:

Gregory A. Abel, MD, MPH , can be reached at Dana-Farber Cancer Institute, 450 Brookline Ave., Boston, MA 02215; email: gregory_abel@dfci.harvard.edu.

Zachary A.K. Frosch, MD , can be reached at Dana-Farber Cancer Institute, 450 Brookline Ave., Boston MA, 02215.

Disclosure s : The authors report no relevant financial disclosures.

itj+ Perspective

Author Name
Perspective

Drug shortages are well known in medicine. However, surprisingly few data exist detailing the general public’s awareness and perceptions about this problem, particularly in oncology. To shed light on this topic, Frosch and colleagues conducted a study of the adult U.S. population designed to represent a wide range of geographic, demographic and socioeconomic factors. Study participants completed a survey detailing their general awareness and opinions about drug shortages.

Importantly, the authors found that, overall, participants had a low level of awareness of drug shortages (14%). Awareness appeared higher among individuals with a personal history of cancer (31%). In addition, patients overwhelmingly wanted to be informed about shortages leading to a substitution that had a minor difference (82%) or major difference (87%) in efficacy.

White individuals, those with higher household income and those with higher levels of education appeared more likely to be aware of drug shortages. People in these groups also appeared much more willing to transfer care to avoid major differences and drug efficacy should substitution due to shortage be required.

The authors concluded that the U.S. population is largely unaware of drug shortages, and the potential disparity in awareness — as well as willingness to transfer care to avoid differences in efficacy — follow traditional socioeconomic divisions. These data suggest that transparency with patients about shortages is desirable from patients’ perspectives. Given the extent of the drug shortage problem, it is clear additional steps are needed to ensure adequate supply of oncology drugs, as inferior substitutions may disproportionately affect populations already at higher risk for inferior outcomes due to psychosocial, racial and economic factors.

Brian Hill, MD, PhD

Cleveland Clinic Taussig Cancer Institute

Disclosure: Hill reports no relevant financial disclosures.