Impact of anti-cancer drugs shortages in oncology and hematology departments in a Moroccan hospital

Abstract

Introduction Drug shortages have been a growing global problem in recent years. Some of them are of vital necessity and importance for the patient, such as those used to treat pathologies in clinical hematology and oncology departments. The objectives of this study are to determine the impact of anti-cancer drugs shortages on both: treatment and patient in the hematology and oncology departments, to describe the actions that have been put in place to manage the shortages and to survey patients about their perspectives and experiences. Materials and methods It was a prospective, observational study, it took place in the oncology and hematology departments. It was carried out with the help of an operating sheet, which contained two parts: patient and treatment data. This sheet was filled out after the interview with the patient and on the basis of the medical file. Results Of the 101 patients interviewed, 67.3% were impacted by the shortage of drugs. The treated pathology that was most impacted by the rupture was Non-Hodgkin lymphoma (55.8%), vincristine was the drug most responsible for the shortages (34%). Most patients (51.4%) went to a non-local pharmacy to buy the medicine that was in short supply in the hospital. Delayed care was the main impact of the drug shortage (42.6%). As a result of these shortages, the majority of patients (45.6%) were frustrated and anxious about the situation. Conclusion Drug shortages have a profound impact on patient safety, clinical outcomes, quality of treatment, hospital management and other important factors. In-depth collaboration between different health actors and timely communication strategies are essential elements of an effective drug shortage management plan.

Experience of Pharmacists with Anti-Cancer Medicine Shortages in Pakistan: Results of a Qualitative Study

“…Most participants highlighted suboptimal treatment and delayed treatment along with increased out-of-pocket costs. Similar results are found in studies from the US, Egypt [ 32 ] and Morocco [ 33 ]. The results are also consistent with another recent study carried out in Pakistan [ 32 ] and the one carried out in the US where 65.0% of the participants mentioned delayed treatment due to shortage [ 16 , 34 ].…”

“…In the case of proactive activities, even after well anticipation, financial constraints limit the procurement capacity, and only a few private setups or well-established NGO-based hospitals could be able to procure up to their need and for procuring more brands, only a few generics/brands are approved. For counteractive strategies, managing within hospitals leads to a change of protocol (rescheduled expensive treatment with or without compromised outcomes) [ 28 ], delayed treatment, and switching to alternatives (expensive second or third-line agents with less efficacy increased chances of medication error), all three would impact the optimum health outcomes to some extent [ 27 , 33 , 37 ].…”

“…Moreover, pharmacists or patients themselves have to purchase drugs from the gray market, where the short drugs are expensive and have compromised efficacy. In this case, the out-of-pocket cost for the patient will increase more due to purchasing expensive drugs [ 33 ]. Furthermore, arranging through import is an expensive and lengthy process that lags the treatment duration of the patients who are already vulnerable to a chronic condition at a specific disease stage [ 17 ].…”

Adverse drug reaction related to drug shortage: A retrospective study on the French National Pharmacovigilance Database

“…3 For patients, drug shortage usually leads to changes in medications and/or involuntary discontinuation that may compromise their safety due to a lack of efficacy or the occurrence of a medication error and/or an adverse drug reaction (ADR). In the literature, cases of ADRs and medication errors have been reported in the context of drug shortage involving anti-cancer drugs, 4,5 anaesthetic products [6][7][8] and anti-infective drugs. 9 The present study aimed to provide an overview of ADRs, medication errors and inefficiency occurring in the context of drug shortage based on the reports collected in the French National Pharmacovigilance Database.…”

“…For patients, drug shortage usually leads to changes in medications and/or involuntary discontinuation that may compromise their safety due to a lack of efficacy or the occurrence of a medication error and/or an adverse drug reaction (ADR). In the literature, cases of ADRs and medication errors have been reported in the context of drug shortage involving anti‐cancer drugs, 4,5 anaesthetic products 6–8 and anti‐infective drugs 9 …”