Most Americans are unaware of cancer drug shortages, according to the results of a nationally representative survey.

But most would want to know about drug substitutions with differences in efficacy or safety, reported Zachary A.K. Frosch, MD, of the Dana-Farber Cancer Institute and Brigham and Women’s Hospital, Boston, with his associates. Most also would transfer care to avoid receiving a substitution with substantially lower efficacy or safety, the researchers wrote in Cancer.

Drug shortages have plagued oncology for years. In a recent survey of U.S. oncologists who treated lung or colorectal cancer, 74% had experienced a shortage of at least one injectable therapy in the prior year, and 28% had used a less effective alternative as a result (J Oncol Pract. 2015;11:e152-62). However, little is known about public awareness and response to these shortages.

Therefore, the investigators used a 13-item instrument to survey 420 U.S. adults about their personal cancer history, as well as their knowledge and preferences regarding drug shortages and substitutions. Respondents were chosen randomly from a demographically representative online sample.

Only 16% of respondents said they were aware of drug shortages (including 31% of those with a personal cancer history and 14% of those without one), but more than 80% would want to be told about resultant substitutions with major or minor differences in safety or efficacy.

Furthermore, most respondents said they would transfer care to avoid a substitution: 72% for major efficacy differences and 61% for major safety differences. Respondents who were black, of low educational or socioeconomic level, uninsured, or unemployed were less likely to transfer care because of substitutions.

The findings show the need for more clinician-patient counseling about drug shortages, Dr. Frosch said in a media release.

“It can be stressful for patients with cancer to learn that their care may be impacted by drug shortages, but it’s important for oncologists to engage patients in these discussions,” he said. “Our data suggest that people expect disclosure of shortages as part of the caregiving process.”

More public awareness might also pressure stakeholders to tackle systemic failings underlying these drug shortages, he said. “It’s important that everyone – clinicians, patients, and the public – have a seat at the table as these strategies are developed.”

No specific funding was disclosed. The investigators reported no disclosures.

SOURCE: Frosch ZAK et al. Cancer. 2018 Apr 8. doi: 10.1002/cncr.31246.

Cassandra D. Benge, PharmD

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