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These impressive cure rates rely on a stable supply of these older generic drugs. Yet 80% of the most common drugs used to treat ALL have been in short supply over the past decade, a situation that exasperates pediatric hematologists/oncologists like Yoram Unguru, MD, MS, MA at the Herman & Walter Samuelson Children’s Hospital at Sinai in Baltimore, Maryland, and Johns Hopkins Berman Institute of Bioethics. He sees firsthand how drug shortages can increase medication errors, delay lifesaving treatments, and lead to patient deaths. “Children with cancer are particularly vulnerable to drug shortages,” says Unguru. “Shortages prevent my colleagues and me from providing a reasonable standard of care and represent a national disgrace.”

In the first three quarters of 2016, the American Society of Health-System Pharmacists, which gathers data on national drug shortages, recorded 120 new occurrences and 174 active drugs in short supply, including a significant number of chemotherapeutics.2 The bulk of shortages are caused by economic factors, manufacturing and quality problems, and, to a lesser degree, regulatory concerns.

“We see the most shortages with generics, specifically generic injectable products, because they have low profit margins and are difficult to make,” says Erin Fox, Director of the Drug Information Service at University of Utah Health Care in Salt Lake City, Utah. This affects chemo treatments, which are mostly delivered by injection. “Capacity is also an issue. Most manufacturers are running 24/7 so there isn’t additional capacity for a supplier to make up the difference if a problem on a manufacturing line occurs.”

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