APHON Pediatric Chemotherapy-Biotherapy Renewal

shortage of normal saline; it was rather a shortage of the sterile minibags that were manufactured in Puerto Rico (Unguru, 2020). Those in the field of pediatric oncology have received little guidance for dealing with drug shortages. Figure 1 graphs the percentage of Children’s Oncology Group (COG) principal investigators and pharmacists who indicated that a shortage of chemotherapy agents had affected clinical trials in the period 2013–2015 (Salazar et al., 2015).

Figure 1. Impact of Drug Shortages on Clinical Trials From “The Impact of Chemotherapy Shortages on COG and Local Clinical Trials: A Report from the Children’s Oncology Group,” by E. G. Salazar, M. B. Bernhardt, Y. Li, R. Aplenc, and P. C. Adamson, 2015, Pediatric Blood and Cancer , 62 (6), p. 942 (https://doi.org/10.1002/pbc.25445). Copyright 2015 by Wiley Periodicals, Inc.

Ethical Considerations Children with cancer are particularly vulnerable to the impact of drug shortages, so the shortages present significant ethical challenges (Decamp et al., 2014). Substitute regimens need to be carefully examined before they are adopted because they can result in inferior patient outcomes. APHON does not support unethical practices (such as drug hoarding or discrimination based on patients’ age, developmental level, race, ethnicity, disability, immigration status, or ability to pay) that violate the principle of justice. Unsafe strategies of waste reduction, such as those that violate infection prevention protocols (e.g., reusing drugs, administering expired drugs) or compromise the quality of care are also unethical (Bunnell et al., 2020). It is essential that decision making on drug allocation be founded on ethical principles. Moreover, the healthcare team must ensure that communication with patients and families about drug shortages is explicit and transparent. Ethical issues that may arise in the event of drug shortages may be related to decisions in these areas: delays in treatment, the skipping of a