Pediatric and bioethics experts have issued a framework to guide prioritization decisions among children in need of life-saving chemotherapy.1

Shortages of life-saving chemotherapy and supportive care agents occur frequently, and there are no concrete guidelines for dealing with these shortages.2

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“Physicians and administrators faced with having to decide which of 2 children with cancer receives scarce life-saving treatment need guidance and should not feel that they are on their own without a roadmap,” said Yoram Unguru, MD, MA, MS, lead author of a commentary published in the Journal of the National Cancer Institute and a pediatric hematologist/oncologist at The Herman and Walter Samuelson Children’s Hospital at Sinai and a faculty member of the Johns Hopkins Berman Institute of Bioethics.1

The proposed framework is a 2-step allocation process that includes strategies to address shortages by minimizing waste and addresses prioritization across and within diseases according to a “modified utilitarian model that maximizes total benefit while respecting limited constraints on differential treatment of individuals.2

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The framework minimizes bias and provides reasoning for explicit decision-making in the face of an actual drug shortage. It emphasizes that decisions should be based on evidence. Curability, prognosis, and the importance of a particular drug to a patient’s outcome are critical factors to consider.

“The context of allocation is always complex, but it is unethical to leave these challenges unaddressed,” Unguru said. “It is our hope that this framework will be helpful and spur further substantive action on this crucial issue.”


  1. Oncologists issue guidance for allocating scarce chemotherapy drugs [news release]. Oxford University Press USA; January 29, 2016. Accessed February 1, 2016.
  2. Unguru Y, Fernandez CV, Bernhardt B, et al. An ethical framework for allocating scarce life-saving chemotherapy and supportive care drugs for childhood cancer. JNCI. 2016;108(6):djv392. doi: 10.1093/jnci/djv392.