A new survey looks at how drug shortages affect cancer patients.(Photo: USA TODAY)
Karen Weintraub, Special for USA TODAY
Certain cancer drugs were in such short supply in 2011 that patients were going without, taking untested medications and were subjected to prescription errors because of changes in routine, finds a survey of health professionals published today.
Almost all of the 240 hospital and clinic pharmacists polled said they had to change or delay treatments because of the shortages, said the study, by researchers at St. Jude Children's Research Hospital in Memphis. It was published in the American Journal of Health-System Pharmacy.
"We wonder, how can drug shortages occur in the United States?" says physician Richard Theriault, a breast cancer specialist at The University of Texas' MD Anderson Cancer Center in Houston, who was not involved in the study. "And the patients look at us like we're from Mars. 'What do you mean there's no drug?' We don't know."
Although some say availability has improved over the last 18 months, Theriault says he still has to do without crucial drugs sometimes and try "to come up with an alternative that may or may not be as effective."
Those alternatives have not been well studied, and the pharmacists reported that dozens of patients had suffered worse side effects or even failed treatment because of the substitutions, according to the study. The drugs in shortest supply were Liposomal doxorubicin, Fluorouracil, Leucovorin and Paclitaxel, which are used to treat a variety of cancers, including breast, ovarian and colorectal.
"Many times there's no good therapeutic alternative," says James Hoffman, a study author and St. Jude's medication outcomes and safety officer.
Substitutions cost more money, and errors increase when pharmacists and nurses can't use medications they know well, the study found.
The shortages are the result of a variety of factors, Hoffman says, from sloppy manufacturing practices flagged by federal investigators, to the economics of the drug industry. The medications still in shortest supply, he said, are generic, sterile injectable drugs, including multivitamins.
Erik Krull, of Covington, Tenn., saw the importance of those vitamins two years ago when his daughter Lucy, then 5, was undergoing treatment for brain cancer. Just after celebrating the end of her six weeks of radiation and keeping down her first solid food since the treatment began, Lucy complained that her eyes were bothering her. Her parents thought it was exhaustion and sent her to bed.
The next morning her eyes couldn't focus, and she could barely see. "We immediately jumped in the car and took her to St Jude's, scared out of our minds," Krull says, convinced her cancer had returned.
It took doctors five days to discover that her creeping blindness was not the cancer, but a deficiency of vitamin B1, known as thiamine. Within minutes of getting the first vitamin dose, Lucy's vision began to return.
"She'd had cancer, nine hours of surgery, radiation, and then you stick this horrible ordeal on her. It was awful," Krull says.
Lucy is doing "great" now and recently celebrated her 7th birthday, Krull says.
He adds that the situation must be even harder for parents who can't get their sick child a needed chemotherapy drug.
"You're fighting so hard and you're so desperate. I can't imagine knowing that you didn't give them the best option."