06/15/2023

ASCO Provides Guidance for Treating Breast, Gastrointestinal & Gynecologic Cancers During Drug Shortages

The statements below reflect the American Society of Clinical Oncology’s position on the prioritization of antineoplastic agents in limited supply for first intervention; decisions should be based on specific goals of the therapy where evidence-based medicine has shown survival outcome and life-extending benefit in both early and advanced stages. For ethical guidance, please visit our Ethical Principles and Implementation Strategies page.

Effective immediately, ASCO recommends the following:

1. Re-prioritize non-essential use of antineoplastic agents in limited supply. If an alternative agent, intervention, or sequence with comparable efficacy and safety is available, then the limited agent should not be ordered.
2. Increase the interval between cycles and/or reduce the total treatment dose when clinically acceptable. Where nationally recognized guidelines (e.g., ASCO, NCCN, etc.) state a range for cycle duration, default to the longer end of that range (e.g. if platinum is recommended every 3 to 4 weeks, default to every 4). Where guidelines indicate a range of dosing, default to the lowest therapeutically proper dose.
3. Minimize or omit the limited agent for recurrent agent-resistant cancers.
4. Minimize waste by optimizing vial size, dose rounding, and using multi-use vials.
5. Institutions should establish a working multidisciplinary utilization committee to monitor drug shortages, provide and communicate internal policies on utilization, and act as an independent arbiter to promote equitable use of drugs in short supply.
6. Select an evidence-based alternative regimen if adequate supplies are unavailable and consider a second opinion consultation with oncology/hematology colleagues to discuss disease site-specific options.
7. Providers should offer counseling referrals (if available) to patients affected by shortage-related distress.
8. Clinicians should have support services available for shortage-related distress.

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