Fight Against Cancer Drug Shortages Goes Global

"We look to governments to support innovation through fair prices. We look to them for adequately resourced health systems, but health is a right we can only deliver if governments invest in health systems," Mr. Barnes said.

Changing the law is one thing, he said, but there also needs to be a health system in place to ensure that health interventions can successfully be delivered.

European Situation More Complex

"There are two issues at stake here as far as I can see, first is availability and second affordability," said hematologist Dr. Anton Hagenbeek of the Academic Medical Center at the University of Amsterdam in the Netherlands.

ASH is well ahead of the EU in keeping track of the drugs shortages problem, Dr. Hagenbeek observed. Indeed, ASH has collected data on hematologic drug shortages via its dedicated drug shortages portal for the past 18 months and regularly reports its findings to the Food & Drug Administration.

Drugs currently on the ASH/FDA shortage list include many generic, injectable drugs, including methotrexate, leucovorin, bleomycin, anthracyclines, and cisplatin, to name a few. According to the ASH press statement, more that 200 drugs were reported to be in short supply in the United States at one point last year, several dozen of which were critical to the care of patients with hematologic disorders.

The situation in Europe is undoubtedly more complex than in the United States, Dr. Hagenbeek observed. "We are not 1 country; we are 27 countries with our own rules and regulations."

Although it seems as if the EU has fewer drug shortages, compared with the United States, the number of incidents is increasing annually, he noted, citing a sudden shortage last year of cytosine arabinoside in the Netherlands.

The lack of an inventory to keep track of shortages needs addressing, Dr. Hagenbeek said. "Medicine should be available for any patient who needs it and there should be no barriers to access medicine," he said.

"Imagine AML induction without cytosine arabinoside, ALL induction without methotrexate and vincristine, and BEAM without the B, E, and A," Dr. Hagenbeek noted. This is a situation that is "simply unacceptable" for both hematologists as well as patients.

Following the U.S. Example

Speaking from the EHA’s perspective, Dr. Hagenbeek commented that European hematologists should follow the lead set by the United States by creating drug shortage databases in their respective countries and also by reporting drug shortages directly to the society.

Raising awareness is the start, Dr. Hagenbeek suggested. Notification of health authorities, and ultimately, hopefully changing European legislation will be the important next steps.

"EHA is in an excellent position to build on what we have already achieved as ASH in influencing legislation as a first step in dealing with the drug shortage issue," ASH president Armand Keating of the University of Toronto and the Princess Margaret Hospital in Toronto said in an interview.

"I think there are a number of potential solutions," Dr. Keating added, suggesting that an incentive-based rather than punitive-based system might be more successful in addressing drug shortages in the United States in particular.

"One of the things hematologists can do is inform patients about the issue," Dr. Keating suggested, as well as reporting drug shortages to their national health authorities and professional societies such as ASH and EHA.

Dr. Keating, Dr. Jäger, Ms. Cursaru, Mr. Barnes, and Dr. Hagenbeek had no relevant conflicts of interest other than representing their respective societies or professions.