(HealthDay News) — More than 80% of oncologists report being unable to prescribe their preferred chemotherapy agent due to shortages, according to a letter to the editor published in the Dec. 19 issue of the New England Journal of Medicine.

“It is becoming increasingly difficult for patients with cancer to receive the lifesaving treatments they need. … The problem of shortages of cancer drugs is complex, and some factors will take years to resolve. Despite the persistence and serious nature of the problem, empirical data are lacking to quantify oncologists’ experience with shortages,” wrote Keerthi Gogineni, MD, Katherine L. Shuman, BS, and Ezekiel J. Emanuel, MD, PhD, all from the University of Pennsylvania in Philadelphia.

The authors and colleagues collected empirical data to quantify the scope of chemotherapy shortages. Two hundred fourteen randomly selected oncologists who routinely prescribe chemotherapy agents were surveyed from September 2012 through March 2013 regarding the frequency and type of chemotherapy shortages that they had encountered.

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The researchers found that, because of shortages, 82.7% of physicians were unable to prescribe the preferred chemotherapy agent at least once during the previous 6 months. The most commonly reported shortages involved leucovorin, liposomal doxorubicin, fluorouracil, bleomycin and cytarabine, as reported by 66.4%, 61.7%, 18.7%, 17.3% and 16.4% of oncologists, respectively.

Additionally, more than three-quarters of oncologists reported that shortages triggered a major change in treatment, which may have been less effective. More than one-third of oncologists also reported having to delay the start of treatment or choose patients to exclude from treatment.

Most oncologists (59.2%) who experienced shortages also reported substituting a more expensive brand-name drug for a generic chemotherapy agent, increasing the cost of treatment.

Although these scarcities were common, 69.6% of oncologists included in the survey reported that their cancer centers or practices did not have formal guidance in place for making decisions regarding drug allocation. 

“The majority of oncologists face chemotherapy shortages that compromise the delivery of standard cancer care and lead to higher costs,” the authors wrote.

“Since the crisis related to shortages of generic drugs is unlikely to be resolved in the foreseeable future without economic and regulatory intervention, oncologists would benefit from formal guidance on how to address these shortages to mitigate the impact on patients with cancer.”


  1. Gogineni K, Shuman KL, Emanuel EJ. Survey of Oncologists about Shortages of Cancer Drugs. N Engl J Med. 2013;369:2463-2464.