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Impact of an Etoposide Chemotherapy Shortage on Patients With Extensive-Stage Small-Cell Lung Cancer: Results of a

Claire Browne1, Toufic Ayoub2, Nadeesha Samarasinghe3,4

  • 1Division of Medical Oncology, Department of Oncology, Verspeeten Family Cancer Centre, London Health Sciences Centre, Western University, London, ON, Canada.

JCO Oncology Practice
|September 3, 2024
PubMed
Abstract

Insights

The intravenous etoposide shortage in Ontario led to increased hospitalizations and shorter progression-free survival for extensive-stage small-cell lung cancer patients. Cancer drug shortages negatively impact patient care, necessitating secure drug supply strategies.

Area of Science:

  • Oncology
  • Pharmacology
  • Health Services Research

Background:

  • A critical shortage of intravenous etoposide occurred in Ontario, Canada, from 2018 to 2020.
  • This shortage created a natural experiment, influencing treatment decisions based on drug availability.

Purpose of the Study:

  • To assess the impact of the intravenous etoposide shortage (IVES) on patient care outcomes for extensive-stage small-cell lung cancer (ES-SCLC).

Main Methods:

  • Retrospective review of ES-SCLC patients treated during pre-shortage and shortage periods.
  • Time-to-event analysis, Cox proportional hazards, and logistic regression were used to evaluate healthcare utilization and survival.

Main Results:

  • Patients treated during the IVES experienced a significant increase in hospitalizations (OR, 2.30) and shorter progression-free survival (HR, 1.79).
  • Alternative chemotherapy regimens included IV platinum-oral etoposide, IV platinum-IV irinotecan, and oral etoposide monotherapy.

Conclusions:

  • The IVES resulted in poorer outcomes for ES-SCLC patients, including increased hospitalizations and decreased progression-free survival.
  • Cancer drug shortages pose significant risks to patient care, highlighting the need for robust drug supply chains and mitigation strategies.

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