Survey finds persistent shortages of foundational cancer drugs at U.S. centers

The survey asked centers about current shortages, which agents were affected, how shortages compared with prior years, effects on clinical trials and community practices, and what mitigation steps centers are using.

• Clinical trials and community impact: 39% of centers said shortages affected clinical trials. Seventy‑seven percent reported shortages were affecting community practices in their area.

An independent analysis by United States Pharmacopeia noted that drug shortages across many therapeutic areas are lasting longer than before, with an average duration exceeding five years. NCCN began surveying members after concerns about shortages of generic chemotherapy drugs such as cisplatin and carboplatin emerged in previous years.

Nearly all centers (93%) reported they have been able to continue treating patients according to intended dose and schedule, though many relied on mitigation strategies. The survey identified commonly used approaches:

• Waste management (79%) to preserve limited vials or doses.
• Limiting use of current stock (43%) to prioritize patients with the most urgent need.
• Using the minimum value of a recommended dose range (32%) or the maximum interval of a recommended treatment interval range (21%).

Seventy‑one percent of centers reported having formal multidisciplinary committees to address shortage issues. Those committees typically notify clinical staff of interim protocols (95% of centers using committees), develop therapeutic substitution or conservation protocols (91%), and track inventory.

Crystal S. Denlinger, MD, CEO of NCCN and a medical oncologist at Fox Chase Cancer Center, described the problem as "more of a chronic condition than an acute problem," noting disappointment that increased attention has not produced larger improvements over recent years.

Many modern oncology advances build on older cytotoxic regimens. Centers say older generic drugs remain essential to current treatment algorithms for a range of cancers. When those generics are in short supply, providers must alter schedules, doses, or trial protocols, which can affect patient care and the feasibility of research.

The survey does not prescribe policy solutions, but the responses imply needs for more stable supply of generic chemotherapy agents, broader availability for community practices, and continued investment in coordinated mitigation infrastructure inside centers to manage shortfalls.

Shortages of foundational oncology medications persist across NCCN centers. Most institutions are maintaining intended care through mitigation and coordination, but multiple shortages, ongoing duration, effects on trials, and impact in community settings signal that the underlying supply challenges remain unresolved.