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Oncology drug shortages in the USA — business as usual

Shortages of drugs, including chemotherapeutics, are increasingly common in the USA, and compromise patient care, delay clinical trials and are associated with substantial financial costs. The recent shortage of vincristine, a chemotherapeutic used for most children with cancer and countless adult patients, presents a particularly vexing challenge. Drug shortages can cause patients unnecessary anxiety and challenge clinicians to ration lifesaving medications for which no alternative agent exists. We provide an overview of this problem and discuss potential solutions.

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  1. ASH Clinical News. Vincristine shortages may continue through December. (2019).

  2. US Food & Drug Administration. Drug shortages: root causes and potential solutions. (2019).

  3. Vizient. Drug Shortages and Labor Costs — Measuring a hidden cost of drug shortages on U.S. hospitals. (2019).

  4. Rosenberg M. What do FDA data tell us about the scope and scale of drug shortages? (2018).

  5. NORC at the University of Chicago. Recent trends in hospital drug spending and manufacturer shortages. (2019).

  6. Institute for Safe Medication Practices. A shortage of everything except errors: Harm associated with drug shortages. (2012).

  7. [No authors listed]. Drug shortages roundtable: minimizing the impact on patient care. Am. J. Health. Syst. Pharm. 75, 816–820 (2018).

  8. Edney, A. Facing cancer drug shortages, U.S. relies on banned chinese plant. (2019).

  9. Metzger, M. L., Billett, A. & Link, M. P. The impact of drug shortages on children with cancer — the example of mechlorethamine. N. Engl. J. Med. 367, 2461–2463 (2012).

    Article  CAS  Google Scholar 

  10. Fox, E. R., Sweet, B. V. & Jensen, V. Drug shortages: a complex health care crisis. Mayo Clin. Proc. 89, 361–373 (2014).

    Article  Google Scholar 

  11. Salazar, G. E. et al. The impact of chemotherapy shortages on COG and local clinical trials: a report from the Children’s Oncology Group. Pediatr. Blood Cancer 62, 940–944 (2015).

    Article  CAS  Google Scholar 

  12. Woodcock, J. To help reduce drug shortages, we need manufacturers to sell quality — not just medicine. (2019).

  13. Dill, S. & Ahn, J. Drug shortages in developed countries — reasons, therapeutic consequences, and handling. Eur. J. Clin. Pharmacol. 70, 1405–1412 (2014).

    Article  Google Scholar 

  14. Unguru, Y. et al. Chemotherapy and supportive care agents are essential medicines for children with cancer. JAMA Pediatr. 173, 477–484 (2019).

    Article  Google Scholar 

  15. S.2723 — Mitigating Emergency Drug Shortages Act. (2019).

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Correspondence to Erin R. Fox or Yoram Unguru.

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Competing interests

University of Utah Health is a member of a Group Purchasing Organization, Vizient. The University of Utah Drug Information Service (UUDIS) has a contract with Vizient to provide them with information on drug shortages. The value of this contract is <5% of the budget for this nine-person unit. No funds are paid to E.R.F. The UUDIS provides all of the content for the American Society of Health-System Pharmacists (ASHP) drug-shortage website at In the past 36 months, E.R.F. has received partial travel support (no honoraria) to provide continuing education or presentations from The Idaho Society of Health System Pharmacists, the Massachusetts Society of Health System Pharmacists, the Anesthesia Patient Safety Foundation, the American Society of Anesthesia, the ASHP, the University of Illinois at Chicago, the National Academies of Sciences, Engineering, and Medicine, the FDA, the Mayo Clinic, the European Cooperation in Science & Technology (COST), the Immunoglobulin National Society, the Association of Critical Care Transport and the Center for Infectious Disease Research and Policy. E.R.F. has also had an unpaid advisory position at CivicaRx. Y.U. declares no competing interests.

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Fox, E.R., Unguru, Y. Oncology drug shortages in the USA — business as usual. Nat Rev Clin Oncol 17, 128–129 (2020).

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