Consistent, reliable access to medication is important for the ongoing health of Canadians.
We have come to expect that we will get the medications we need, when we need them. But even in Canada, there are times when drug shortages occur and demand cannot be met. This is a serious matter for anyone who depends on specific medications regularly in order to maintain their treatment plan; it can be especially significant for cancer patients who have very specific requirements in timing and adherence to their treatment regimes and supportive care medications.
Drug manufacturing – and indeed, the entire drug supply chain – is complex and requires precision at many stages. A drug shortage can occur if there is an issue at any point along the supply chain.
A shortage can happen at the supply level, where the manufacturer can’t get the active ingredients or raw materials required to make the medication.
Or, it can come at the manufacturing stage, which is the point where the drug’s ingredients are processed into their final form, like capsules, tablets, injections, creams or ointments. Manufacturing-related shortages may be the result of: Contamination or quality control issues, production line capacity issues, or stoppages in the manufacturing production line. Also, some manufacturing facilities use the same machinery to produce multiple different medications, so a delay or increased demand in one medication may lead to a delay in another.
The possibility for a manufacturing-related drug shortage is especially relevant in the production of biologic medicines. Because they are made from living cells, biologics are particularly complex, sensitive and fragile—moreso than small molecule drugs. That heightened complexity introduces room for additional complications, delays or quality control issues that could result in a drug shortage.
A shortage can also occur as a result of a surge in demand for a particular drug, with a lag in supply catching up.
And there could also be economic considerations at play, whereby the drug manufacturer makes a business decision to halt production altogether due to low demand or other reasons.
The bottom line is that the steady flow of all medications isn’t a given. Shortages happen. And a shortage could potentially lead to an interruption of treatment, which could be problematic. This is something that patients need to be keenly aware of when speaking with their doctors.
Given the delicate nature of cancer care, timing can be everything. Patients on chemotherapy need to be especially vigilant that they will have access to the medications they need throughout their rounds of treatment. This is not only the case with the treatments themselves, but also their supportive care. Febrile neutropenia (FN), for example, is a serious side effect of chemotherapy. Left untreated, FN can potentially be life-threatening. Making sure that cancer patients have access to the supportive care they need to decrease the risks of chemotherapy, means they are receiving the best treatment possible and can remain focused on getting better.
Patients can take steps to mitigate the risk of being affected by a shortage. The website drugshortagescanada.ca tracks current and past drug shortages. It can be a useful resource for anyone discussing their treatment options with their doctor.
Patients going through cancer and chemotherapy treatment should consider asking their physicians the following questions about their prescription medication:
- Of the available medication options, are there any that have had a history of drug shortages?
- Are there risks associated with missing treatments on account of drug shortages?
- Are there alternative treatments that might be suitable for me?