Should Cancer Drugs Be Rationed?

A Los Angeles-based advocacy group for pediatric cancer patients has proposed a framework to cope with ongoing and future shortages of oncology drugs.

The proposal, put forth by the Children's Oncology Group and published in the Journal of the National Cancer Institute, suggests a combination of identifying which drugs are in shortage, evaluating the severity of the shortage, and then formulating an allocation plan for such drugs.

Actions that can be taken during the identification process include contacting other hospitals to evaluate their supply, contacting pharmaceutical manufacturers, and suggesting viable alternative treatments. Any drug in severe shortage should be considered the equivalent of a national emergency.

“Viewing a drug shortage as a natural disaster or a natural emergency achieves more than raising public awareness; it also provides a mechanism for potential policy change,” wrote the authors, seven pediatric oncologists affiliated with a variety of academic medical centers in the U.S. 

Regarding allocation, the authors suggest evaluating the particular cancer each patient has in relation to the drugs they require and their curative power relative to each condition. Drugs such as methotrexate should be allocated to patients with leukemia over osteosarcoma. Patients with sarcomas should receive doxorubicin over patients with with Hodgkin’s lymphoma.

“Solving the drug shortage problem will ultimately require a major policy shift, one that is grounded in coordination and cooperation. Until that time comes, individuals and institutions that care for children with cancer must be prepared to make difficult decisions about allocating scarce life-saving chemotherapy,” the authors concluded. “If shortages...persist despite mitigation strategies, prioritization should be based upon maximizing benefit according to total lives or life-years saved.”