Methotrexate Scarcity Among Children's Oncology Group Institutions: Results of a Multinational Survey

Shortages of curative chemotherapy agents for children and adults with cancer are ubiquitous. These shortages directly result in compromised outcomes, increased medication errors, heightened cost to health systems, and patient deaths. Methotrexate is a staple of many curative childhood cancer regimens and is frequently in scarcity. No national guidance to manage methotrexate and other chemotherapy shortages exists. To assess the effect of the current methotrexate shortage, a multinational survey of Children's Oncology Group (COG) member institutions was conducted. Wide variation in the scope of methotrexate shortage in the US was demonstrated; some centers experienced significant scarcity while others experienced no shortage. Methotrexate mitigation strategies differed by COG site, resulting in potential to exacerbate differential access to life-saving medication and inequities in care. Preventing chemotherapy shortages remains a challenge. In the interim, standard guidance to assist clinicians to equitably and fairly cope with methotrexate and related drug shortages is needed.