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.
Effective immediately, ASCO recommends the following:
- 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.
- 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.
- Minimize or omit the limited agent for recurrent agent-resistant cancers.
- Minimize waste by optimizing vial size, dose rounding, and using multi-use vials.
- 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.
- 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.
- Providers should offer counseling referrals (if available) to patients affected by shortage-related distress.
- 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.
Disease Site-Specific Guidance
- Breast Cancer
- Gastrointestinal Cancer
- Genitourinary Cancer
- Gynecologic Cancer
- Head & Neck Cancer
- Thoracic Cancer