ASCO established a Drug Shortages Advisory Group to assist in the development of the below clinical guidance. View Advisory Group membership and disclosures. ASCO is proud to have collaborated with the Society of Gynecologic Oncology (SGO)  to develop the general guidance below, adapted from their communiqué on carboplatin and cisplatin shortages. ASCO also endorses SGO's gynecologic cancer-specific guidance.

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. Information can also be found in the JCO publication “ASCO Ethical Guidance for the Practical Management of Oncology Drug Shortages.”

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.

            •  Institutions should communicate to clinical staff about measures being taken to address drug shortages and resources available to help oncology care teams manage distress.
            •  Drug shortages impact clinicians, members of oncology care teams, and multidisciplinary allocation committees, and the inability of the care teams to provide optimal treatment may cause psychological or moral distress requiring support
            •  Institutions, practices, clinician societies, and others, should provide or offer referrals for support services such as peer-to-peer, counseling, discussion forums, or any other services addressing the distress or challenges inherent in providing care in the setting of drug shortages. Of note, ASCO member services also include the ASCO Safe Haven clinician support program, and several national resources focused on moral distress can be found here.

ASCO Clinical Guidance for Alternative Treatments

JCO Article

Disease Site-Specific Guidance

Answers to questions about oncology drug shortages published herein are provided by the American Society of Clinical Oncology, Inc. (“ASCO”) for voluntary, informational use by providers in the rapidly evolving drug shortage crisis. This information does not constitute medical or legal advice, is not intended for use in the diagnosis or treatment of individual conditions, does not endorse products or therapies, recommend or mandate any particular course of medical care, and is not a statement of the standard of care. New evidence may emerge between the time information is developed and when it is published or read. The information is not comprehensive or continually updated. This information is not intended to substitute for the independent professional judgment of the treating provider in the context of treating the individual patient. ASCO provides this information on an “as is” basis, and makes no warranty, express or implied, regarding the information. ASCO specifically disclaims any warranties of merchantability or fitness for a particular use or purpose. ASCO assumes no responsibility for any injury or damage to persons or property arising out of or related to any use of this information or for any errors or omissions. Use of the information is subject to the complete ASCO website Terms of Use.