Lauren V Ghazal, Supriya Mohile, Kah Poh Loh, Karen Mustian, Grace Sventek, Umang Gada, Chin-Shang Li, Eva Culakova, Melyssa Foust, Judith O Hopkins, Heather Kehn, Charles Kamen, Erin R Fox, Elaine L Hill
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引用次数: 0
Abstract
Purpose: Drug shortages represent a challenge in oncology care, with potential repercussions including suboptimal treatment options, treatment delays, and medication errors. However, there is scant evidence on how drug shortages interrupt cancer care delivery (CCD) nationally and specifically across National Cancer Institute (NCI) Community Oncology Research Program (NCORP) community oncology practices.
Methods: Between December 2020 and July 2024, 96 NCORP community oncology practices were enrolled. NCORP practice study staff completed the Drug Shortage Baseline Survey and Pharmacy Baseline Survey. The primary outcome was proportion of practices seriously affected by drug shortages (ie, encountered CCD problems [change to less effective treatments, adoption of more toxic alternatives, treatment delays, or an increase in medication errors or near misses]) in the past 3 months. Secondary outcomes included CCD problems among practices (eg, ethical dilemmas) and strategies used by practices (eg, use of alternative drugs, stockpiling). Finally, we described differences between seriously affected and nonaffected practices.
Results: Nearly 54% of NCORP practices were seriously affected by drug shortages in the past 3 months, with 23 drugs (including carboplatin [24.7%], leucovorin [22.6%], and cisplatin [19.4%]). Seriously affected practices were more likely to report lack of suitable alternatives (34.7% v 13.6%), substantial resources spent (70.8% v 50.0%), and change to alternative administration (73.5% v 52.3%) and were less likely to hire staff to address shortages (16.3% v 36.4%). Strategies to address shortages included using alternative drugs (91.5%), stockpiling (87.2%), and developing action plans (84.0%). Most (50.5%) practices reported experiencing an ethical dilemma related to a drug shortage.
Conclusion: Drug shortages influenced CCD among NCORP practices. This study underscores the need for robust strategies and policies to mitigate these effects and enhance the resilience of oncology practices.
目的：药物短缺是肿瘤治疗面临的挑战，潜在的影响包括次优治疗方案、治疗延误和用药错误。然而，关于药物短缺如何在全国范围内，特别是在国家癌症研究所（NCI）社区肿瘤研究计划（NCORP）社区肿瘤实践中中断癌症护理服务（CCD）的证据很少。方法：在2020年12月至2024年7月期间，纳入96家NCORP社区肿瘤诊所。NCORP执业研究人员完成了药物短缺基线调查和药房基线调查。主要结果是过去3个月受药物短缺严重影响的实践比例（即遇到CCD问题[改为效果较差的治疗方法，采用毒性更大的替代品，治疗延误，或药物错误或接近遗漏的增加]）。次要结果包括实践中的CCD问题（例如，伦理困境）和实践使用的策略（例如，使用替代药物，储存）。最后，我们描述了严重影响和非影响实践之间的差异。结果：近3个月，近54%的NCORP药房存在严重的药品短缺问题，共有23种药物（包括卡铂[24.7%]、亚叶酸钙[22.6%]、顺铂[19.4%]）。受严重影响的实践更有可能报告缺乏合适的替代方案（34.7% vs 13.6%），大量资源花费（70.8% vs 50.0%），以及更换替代管理（73.5% vs 52.3%），并且不太可能雇用员工来解决短缺（16.3% vs 36.4%）。解决短缺的策略包括使用替代药物（91.5%）、储备药物（87.2%）和制定行动计划（84.0%）。大多数（50.5%）诊所报告遇到了与药物短缺有关的道德困境。结论：药品短缺影响了非营利性医疗机构的CCD。这项研究强调需要强有力的战略和政策来减轻这些影响，增强肿瘤学实践的弹性。
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