The American Society of Clinical Oncology (ASCO) put together a multidisciplinary panel to provide clinical guidance amid the chemotherapy shortage. The panel is comprised of oncologists, ethicists, and patient advocates and is designed to help providers navigate instances in which rationing therapies or considering alternative therapies is necessary.
The 44-person group devised a set of general guiding principles providers can refer to during drug shortages, including subsets for specific disease types.
General guidelines are as follows:
- Reprioritize nonessential use of antineoplastic agents in limited supply. If an alternative agent, intervention, or sequence with comparable efficacy and safety is available, the limited agent should not be ordered.
- Increase the interval between cycles and reduce the total treatment dose when clinically acceptable. Where nationally recognized guidelines state a range for cycle duration, default to the longer end of that range, and where guidelines indicate a range of dosing, default to the lowest therapeutically proper dose.
- Minimize or omit the limited agent for recurrent agent-resistant cancers.
- Minimize waste by optimizing vial size, dose rounding, and using multiuse vials.
- Institutions should establish a working multidisciplinary utilization committee to monitor drug shortages, provide and communicate internal policies on utilization, and act as an independent arbiter to promote equitable use of drugs in short supply.
- Select an evidence-based alternative regimen if adequate supplies are unavailable and consider a second opinion consultation with hematology/oncology colleagues to discuss disease site-specific options.
- Providers should offer counseling referrals (if available) to patients affected by shortage-related distress.
- Clinicians should have support services available for shortage-related distress.
To view the detailed guidelines and suggested treatment options for specific diseases, go to ascopubs.org/doi/10.1200/OP.23.00545.
Source: Journal of Clinical Oncology, November 14, 2023.
