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Low supply of some cancer drugs concerns hospital pharmacies

Hospital pharmacies are keeping a careful eye on certain cancer drugs that are in short supply, hoping to ensure that Canadian patients who need chemotherapy treatments don't face delays.

"Given the nature of cancer, clearly, and given the timeliness and the need for access to oncology drugs, it is a very serious cause for concern," said Jeff Morrison, director of government relations and public affairs for the Canadian Pharmacists Association.

In some cases, he said that alternatives can be prescribed.

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"The problem is when a doctor or when a pharmacist doesn't know whether a particular oncology drug will be in short supply and doesn't know when … supply may be resumed of that drug. It's really difficult to be able to plan alternatives," he said in a telephone interview from Ottawa.

Hospira, a pharmaceutical delivery company based in Saint-Laurent, Que., is one of two major suppliers in Canada of a drug that is made overseas and is in short supply.

"The one that appears to have the most sensitivity right now is carboplatin, and as far as providing an estimated time of when things will be back to normal is a little hard," Gerry Stefanatos, Hospira's vice-president for Canada and Latin America, said in an interview Friday.

"One of the key suppliers apart from us has been off market for a little while, so it's putting quite a bit of strain on our ability to fully support the requirements right now. We're getting product on a regular basis but … it seems to fly out very quickly."

Tamara MacDonald, a clinical pharmacy specialist at IWK Health Centre in Halifax, said carboplatin is used mainly when solid tumours have been diagnosed.

The hospital is aware of the supply situation, but so far she said it hasn't had an impact on patient care.

"What we normally do is if we hear that there's going to be a shortage, then we try and get whatever the company is willing to give us," she said.

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"So we put in an order to try to be proactive, and if not, then we go to other hospitals and see if they have supply that we can use."

Every year, the hospital treats approximately 55 to 65 newly diagnosed cancer cases in children up to age 18.

Esther Fung, director of pharmacy operations at University Health Network in Toronto, said they're feeling stress because of the situation with carboplatin, which is used to treat breast, lung, ovarian and other cancers.

"A couple weeks ago we were impacted clinically because we ran out for one day, but we managed to keep the supply in for the following week – so we were OK. It's really minimal clinical impact at this time."

She said about 10 patients were affected, but they were rescheduled for the next day.

"We really have to plan ahead. So we have up to a week and a little bit on hand," Ms. Fung said.

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"We really need to plan with the physician as well if there's any alternative way of treating our patients or if we need to change the schedules, and try to make the minimum impact clinically to our patients."

She said they're in close contact with the two drug companies involved, Hospira and Teva. "Every week we have to call them to make sure we have another week's supply to come into our hospital."

Mr. Stefanatos said Hospira is doing its best.

"We're working 24-7 in our facilities to try and pick up as much of this short supply, to help out as much as we can."

Ms. Fung said vincristine is another chemo drug that's in short supply, but they have enough for now. As well, an immunosuppressant called melphalan is a concern, she said. It's used in bone marrow transplants.

Ms. MacDonald said drug shortages come and go.

"You get notification of the shortages and the company obviously produces more and then it goes again," she said, noting that there have been worries also about cytarabine, a chemotherapy agent often used to treat patients with leukemia.

"It was last summer that we basically thought there might be a potential that we might have to switch therapy in some children, but then we had enough supply in house, which was fortunate, that we could get them through until the company released more drugs."

Eva Thurlow of the breast cancer support group Willow said she imagines that spot shortages of chemotherapy drugs would "cause patients a lot of extra stress and anxiety."

Mr. Morrison of the pharmacists association said there is no national or centralized system that tracks drug supply in Canada, so it's difficult to say when there's a system-wide shortage of a specific drug.

It's tricky to pinpoint reasons for shortages because the drug supply system is a function of the private market and there's no monitoring system, he noted.

Reasons might include shortages of the active pharmaceutical ingredient and operational issues in some plants, he said, adding there's speculation that changes in generic pricing in some provinces have led drugmakers to cut back on or discontinue certain makes of drugs that aren't as lucrative.

The association has been calling for the creation of a drug shortages monitoring system, similar to one in the United States that has a website enabling anyone to find out if drugs are in short supply and when supply is expected to resume.

"We don't have that in Canada," Mr. Morrison said, noting that the supply chain is very fragile. "We're actually trying now to work with manufacturers to create that."

Last October the association did a survey of members and found that a range of drugs were in short supply, including one as common as penicillin.

"Is there one particular type of drug or class of drug that's in short supply? No, it tends to go in waves. But it's really one of the problems we're seeing, as I say over about the past year, has been that there's just so many different types of classes of drugs in short supply that clearly there's an issue and there's some alarm bells going off."

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