Dr. Randy Oyer was at the airport about six weeks ago when his cellphone rang.

It was a York County man who had tracked down the director of Lancaster General Hospital's cancer treatment program in the hopes that he could bring his wife to LGH because she could not get the cancer drugs she needed in their community. Oyer did not have good news for the man.

"I said, even if we have a supply this week, we would not be able to determine if we would have the drug long-term," he said. "We all face this problem every week."

For about the past year, local cancer doctors and hospital pharmacies have been struggling with a shortage of cancer drugs that is affecting the entire nation.

"This year, I have really noticed it," said Dr. Brian Calabrese, medical oncologist with Lancaster Hematology Oncology Care, which practices at Lancaster Regional Medical Center. "The shortages wax and wane, but from the looks of it, it's a problem that won't go away and potentially could worsen in the future."

The shortages are changing the way cancer patients are treated here and elsewhere.

Doctors have had to alter treatment plans, substituting newer medications that do not have the same proven track record for known stalwarts, which are in short supply.

In some cases, they also have had to reduce the dosage of other drugs, those that prevent nausea or treat anemia, for example, or enhance cancer drugs' effectiveness.

In all cases, doctors are trying to get the most effective drugs to those who need them the most. But they don't like straying from what they know works in the treatment of cancer. "Patient care will be affected in ways we can't anticipate," Oyer said. Overall, more than 175 drug shortages have been reported this year, according to the U.S. Food and Drug Administration. The shortages especially have affected older injectable drugs, including cancer drugs, anesthetics, drugs needed for emergency medicine and electrolytes needed for patients on intravenous feeding.
The shortages involving cancer drugs are problematic because they include several of the most common and long-used drugs used in chemotherapy for common cancers such as breast, lung and colon.

"I've been an oncologist for 30 years, and there's never been a time when I've practiced without these drugs," Oyer said. "They have been the backbone of cancer treatments. It's astonishing to me." These are not expensive drugs, doctors said. "I would hate for it to come to a point where we're jeopardizing patients' care because of a lack of supply of essentially cheap medication," Calabrese said.

Doctors and a pharmacy official say several factors are causing the shortage, including the availability of raw materials and manufacturing problems at drug companies.

But profits also play a role in the shortage. The drugs that are hard to get are inexpensive generics that don't generate a lot of income for drug companies, according to doctors.

In the meantime, pharmacies are kept busy scouring the marketplace for drugs and acceptable substitutes and helping to develop alternate treatment plans, said Rich Paoletti, vice president of operations at Lancaster General Health, who oversees the pharmacy. Paoletti said Lancaster General also has lobbied legislators to find a solution for the problem. Oyer personally made a trip to Capitol Hill in March.

U.S. Sens. Bob Casey, of Pennsylvania, and Amy Klobuchar, of Minnesota, introduced a bill earlier this year to try to address the problem. The bill would provide the FDA with tools to address and prevent drug shortages. For example, it would require drug companies to give early notification to the FDA of any incident that would likely result in a drug shortage. Something needs to be done, and soon, to address the problem, Paoletti said. "I would say it's very urgent," he said. "You never know what tomorrow will bring."

~ lancasteronline.com ~