Over the past 15 years, widespread drug shortages have driven US hospitals to navigate the already precarious waters of patient care with limited access to supplies and medications. Oncology drugs have especially fallen victim to chronic shortages, consequently affecting the availability of substitute agents.

As the current paradigm continues to shift toward patient-centered care and shared decision-making, clinicians must recognize their ethical responsibility when managing drug shortages. They must also acknowledge the importance of communicating such circumstances to patients.

Regardless of established ethical guidelines, hospitals continue to respond to drug shortages and therapy substitutions with inconsistency, possibly at the expense of patient health and trust. The American Society of Clinical Oncology published a study in the May 2020 issue of JCO Oncology Practice suggesting that patients receiving cancer treatment prefer objectivity and transparency concerning the discussions and decisions around drug shortages.

In a small exploratory study, the researchers interviewed 39 oncology patients to determine their knowledge about current drug shortages and their preferences for how hospitals manage shortages.

Patients permitted to complete the study were adults who had received oncologic care through the University of Chicago within the past 2 years and had required hospitalization at least once during their course of treatment.

Qualitative interview responses were categorized by themes within 4 domains: awareness of medication shortages/experiences, preferences for type of decision-maker, allocation preferences, and communication preferences. Patients who participated in this exploratory investigation revealed that their views coincided with corresponding bioethical literature regarding equitable distribution of therapies in low supply and how these decisions are made.

This study suggests that patients prefer a drug shortage management strategy that is disclosed and discussed early in the course of treatment, regardless of the shortage’s impact on their therapy. Participants agreed that treatment allocation should be an objective, systematic process informed by multiple perspectives. Patients identified interdisciplinary teams composed of oncologists, pharmacists, medical ethicists, and non-oncology physicians as the most appropriate decision-makers. 

Obvious limitations accompany this small and exclusive study, but it is the first of its kind and researchers plan to continue their investigation on a multi-institutional level. Results from a more comprehensive study are expected to provide insight into the applicability of ethical frameworks across distinct patient populations and essentially inform a patient-centered strategy to communicate and manage drug shortages. 

Reference
Hantel A, Hlubocky FJ, Siegler M, Daugherty CK. A qualitative analysis of oncology patient awareness of medication shortages and their preferences for how shortages should be managed [published online ahead of print, 2020 May 29]. JCO Oncol Pract. 2020;JOP1900608. doi:10.1200/JOP.19.00608

About the Author
Katherine E. MacDonald is a 2021 PharmD candidate at the University of Connecticut.