Global chemotherapy drug shortage triggers SA Health action plan

PATIENTS with common cancers will be forced to use a replacement medication that requires longer treatment and greater risk because of a global shortage of a chemotherapy drug.

SA Health is preparing a statewide action plan to cope with a shortage of ant-cancer drug Etopophos.

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PATIENTS with common cancers will be forced to use a replacement medication that requires longer treatment and greater risk because of a global shortage of a chemotherapy drug.

And a special alert is being sent to healthcare professionals to ensure there is no repeat of the chemotherapy underdosing scandal.

SA Health is preparing a statewide action plan to cope with a shortage of Etopophos, which the Therapeutic Goods Administration expects to be out of stock by the end of October. Supplies are not expected to be restored before next April.

The plan, which takes effect on October 24, is for patients receiving thedrug for small cell carcinoma of the lung, acute monocytic and myelomonocytic leukaemia, Hodgkin’s disease, Non-Hodgkin’s lymphoma and testicular tumours.

However, in a medication alert to healthcare professionals across the health system SA Health stresses the base and phosphate versions are not directly interchangeable.

“Confusion between these products can lead to dosing errors,” it warns in the alert.

The medication orders safety officers to immediately confirm receipt of the alert and circulate it to all clinical areas, and that supervisors ensure all relevant staff are aware of the changes.

The emphasis on ensuring staff respond to the alert follows the chemotherapy underdosing bungle where clinicians ignored an “inadequate and ineffectual” email alert about an error in dosage protocol, according to a review into the bungle.

Following the chemo bungle, a review by the Australian Commission on Quality and Safety in Health Care made six recommendations including new policies to ensure such alerts were acknowledged, which SA Health interim chief executive Vickie Kaminski said were being implemented.

Pharmaceutical company Bristol-Myers Squibb has advised the TGA the shortage is due to an “unexpected interruption in the supply of the medicine’s active pharmaceutical ingredient”.

Etoposide is a chemotherapy agent used to treat a wide range of cancers and is available in Australia for intravenous injection in two forms, etoposide base and etoposide phosphate trademarked as Etopophos.

Under the action plan, from October 24, all such infusions administered at SA Health units will be prepared using only the base product, not the phosphate version falling into short supply.

SA Pharmacy will monitor stock levels and organise transfers between sites as needed.

The action plan notes infusions prepared using the base version require larger volumes of fluid for administration, longer administration times – up to an hour – and have a shorter expiry compared to the phosphate product.

“Longer infusion times will require cancer services to consider and plan for longer appointment times,” the action plan notes. “Shorter expiry dates may mean some higher doses may need to be made up on the day of treatment and on weekends.

“A slightly increased potential for infusion reactions is noted with etoposide and appropriate patient monitoring and treatment should be in place.”