Impact of preparation and execution of strategy to mitigate the platinum shortage within a network of community oncology practices.

Abstract

e13572 Background: The US Oncology Network (USON) is made up of over 600 sites of care and treats 1,400,000 patients annually. Drug shortages have a massive impact on patient outcomes, particularly with limited source oncology medications. Proactive mitigation strategies by the national USON Pharmacy & Therapeutics (P&T) committee are examined to assess impact on cisplatin and carboplatin (cis/carbo) shortages, where a phased approach extended supply for patients. Methods: P&T began implementing gradual reductions in cis/carbo allocations in mid-April 2023. This included stewardship to reserve use in patients with limited alternatives, dose rounding, reducing dose/cycle, and extending cycle interval, when clinically appropriate. As supply depletion became imminent, P&T implemented a novel drug ordering process that restricted cis/carbo use criteria to curative intent without alternative treatment options, requiring case-by-case approval. Comprehensive clinical guidance was developed to provide recommendations for alternative therapies. Alternative regimen templates were built into the centrally managed EHR. To evaluate the impact, drug utilization patterns were tracked during the 6-month shortage (April - September 2023) and compared to historical data. Results: Pronounced impacts were seen during acute supply constraints: cisplatin administrations (admins) and mg decreased to 53% and 48% of baseline, carboplatin admins and mg decreased to 84% and 78%. Compared to the prior 6 months, patients receiving cis/carbo was similar pre-shortage (15,368) vs. during (15,296).Mitigation strategies resulted in preservation of cis/carbo admins for diseases with limited alternatives (NSCLC, head & neck, ovarian/uterine); other cancers with alternatives had a decrease in admins (see table). Dose conservation guidance led to a decrease in average mg administered by 5.1% for cisplatin (72.2 vs. 68.5), and 6.2% for carboplatin (385.5 vs. 361.7). New admins of oxaliplatin increased by 11% (4,230 vs 4,714), primarily in GI malignancies. Conclusions: The rigors of stewardship with a phased approach allowed USON to sustain new patients while conserving cis/carbo for those with limited alternatives. Frequent communication about supply status and conservation guidance was critical for transition to alternative treatment strategies. This experience tested USON organizational readiness for future shortages. [Table: see text]