ASCO’s Quality Care Symposium: Chemotherapy Shortage Resulted in Higher Costs

Studies presented at the upcoming American Society of Clinical Oncology (ASCO) Quality Care Symposium in San Francisco will look at the impact of the 2023 cisplatin shortage, the risk of financial toxicity faced by adolescent and young adult (AYA) cancer patients, and how the use of olanzapine (Zyprexa) reduced severe nausea in patients undergoing chemotherapy.

Cisplatin Shortage

Using data from medical records and claims for 26 practices in the US Oncology Network, researchers found that cisplatin shortages in 2023 resulted in an increase in use of other drugs and higher costs for patients with head and neck cancer.

The study showed that use of cisplatin decreased by 15%, with the lowest utilization (60% decrease) occurring in June and July 2023. The shortage led to an increase in the use of other chemotherapy agents, including carboplatin (40%), paclitaxel (24%), and 5-fluorouracil (5.3%), as well as a 15% increase in the use of cetuximab (Erbitux), reported Puneeth Indurlal, MD, MBBS, of the US Oncology Network, and colleagues.

The average cost per administration was $18 for cisplatin, $14 for carboplatin, $16 for paclitaxel, $22 for 5-fluorouracil, and $2,607 for cetuximab. The increased use of cetuximab, in particular, led to a 16% increase in total cost, with a 144-fold increase in costs at the administration level.

According to the FDA, the national shortage of cisplatin caused by manufacturing disruptions ran from February to August 2023. Of the patients who were receiving cisplatin before the shortage hit, 10% went on to receive another drug due to a lack of availability, Indurlal and colleagues noted.

In the period after the shortage (September 2023 to March 2024), cisplatin volumes rebounded by 8% of pre-shortage use, while carboplatin use dropped below pre-shortage levels. However, cetuximab use remained consistently 12% higher.

Indurlal and colleagues said that since cancer treatment with a specific drug regimen is not usually changed after treatment has begun, patients who started cetuximab during the shortage continued to receive the more expensive drug even when the cisplatin shortage ended.

“Drug shortages have become an all-too-common occurrence in oncology care, disrupting patient treatment, impacting where and how healthcare providers spend their time, and causing broad-ranging effects on the healthcare system,” Indurlal said in a press release. “These results show the multi-faceted consequences of drug shortages and serve to provide evidence in the call-to-action for all healthcare and participating supply chain stakeholders to resolve the problem of drug shortages.”

Financial Toxicity in the AYA Population

The high costs of cancer treatment have hit AYA patients with cancer particularly hard, according to another study that will be presented at the symposium.

A survey of 2,519 patients from the ages of 15 and 39 found that more than half were at risk of experiencing financial toxicity due to treatment costs, reported Kaitlyn Lapen, MD, of Memorial Sloan Kettering Cancer Center in New York City, and colleagues.

The mean Comprehensive Score for Financial Toxicity was 23.2 (score ranges from 0 to 44, with lower scores indicating worse financial toxicity), and 54% had a score under 26. Among those with the worst financial toxicity included patients who had recently received treatment for cancer (β -4.37, P<0.001) and racial/ethnic minority patients (β -3.21, P<0.001).

Lapen and colleagues also found that less than half (44%) of those who screened positive for financial toxicity accepted a referral for available financial assistance, and 28% were unable to afford at least one social need — such as housing (16%), transportation (14%), and food (13%).

In addition, 24% of AYA patients reported using at least some of their savings to pay for treatment, and 7% reported that they had no savings. A quarter of AYA patients borrowed money or took on new loans to pay for treatment.

Finally, among all AYA patients, the average self-reported quality of life (QOL) score on a scale of 0 to 10 (with 0 being “as bad as it can be” and 10 being “as good as it can be”) was 7.3, with financial toxicity associated with a lower QOL score.

“Adolescents and young adults with cancer appear to face high rates of financial toxicity and unmet social needs,” Lapen said in a press release. “Although economic hardships and burdens as a result of cancer diagnosis, treatment, and management may often go unaddressed, they are common and should be acknowledged. Making more people aware of the prevalence and impact of financial toxicity may also galvanize advancements in policy to mitigate financial toxicity.”

Reducing Nausea During Chemotherapy

Results from a randomized phase III trial showed that among patients treated with chemotherapy for breast cancer, olanzapine and prochlorperazine (Compazine) each reduced refractory nausea, with olanzapine demonstrating superior control and significantly improving quality of life.

Among patients with moderate nausea, the average nausea score decreased by about 1 point (scale of 1 to 7, with 7 being extreme nausea) compared with a 0.5 point with placebo, reported Luke Joseph Peppone, PhD, of the University of Rochester Medical Center in New York, and colleagues.

Larger reductions were reported among patients with severe nausea, with a 2.57-point decrease in the maximum nausea score for patients who received olanzapine, a 2.01-point decrease for those who received prochlorperazine, and a 1.30-point decrease with placebo.

Moreover, patients who received olanzapine saw a significant improvement in their overall quality of life compared with the placebo group, while those who received prochlorperazine did not.

The study solidifies olanzapine’s position “as a promising intervention for refractory nausea,” Peppone and colleagues concluded.

“For patients, this means there may be a more effective option available to improve their symptoms and overall well-being during chemotherapy,” said Peppone in a press release. “This could ultimately make the chemotherapy experience more tolerable and manageable, contributing to better overall outcomes and patient satisfaction.”

In this study, 310 patients who experienced moderate or severe nausea after receiving chemotherapy were randomly assigned to receive olanzapine, prochlorperazine, or a placebo combined with standard anti-nausea treatment during their next cycle of chemotherapy.

Please enable JavaScript to view the comments powered by Disqus.