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NCCN Releases Statement Addressing Ongoing Chemotherapy Shortages; Shares Survey Results Finding More Than 90% of Cancer Centers Are Impacted

NCCN—an alliance of leading academic cancer centers—published survey results that shed light on just how widespread the current platinum chemotherapy shortage is, and shared a statement calling on the whole oncology community to work together on solutions.

“This is an unacceptable situation. We are hearing from oncologists and pharmacists across the country who have to scramble to find appropriate alternatives for treating their patients with cancer right now,” said Robert W. Carlson, MD, Chief Executive Officer, NCCN. “We were relieved by survey results that show patients are still able to get life-saving care, but it comes at a burden to our overtaxed medical facilities. We need to work together to improve the current situation and prevent it from happening again in the future.”

The statement from NCCN’s Policy and Advocacy department outlines specific steps that can be taken by the federal government, pharmaceutical industry, providers, and payers to help mitigate any impacts from the anticancer drug shortages. It notes: “The causes and solutions to the recurrent anticancer drug shortages that deprive oncology patients of optimal therapy are multiple and fixable. Effective solutions require a whole of oncology effort if they are to be successful.”

Carboplatin and cisplatin are platinum-based chemotherapies that are frequently used together for systemic treatment, often with the intent to cure. They have been proven to be highly effective across a variety of cancer types, including lung, breast, prostate, and gynecologic cancers, as well as many leukemias and lymphomas. These 2 treatments are indicated hundreds of times throughout the NCCN Drugs & Biologics Compendium (NCCN Compendium)—a searchable database of every recommended medication use found in the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines). They are estimated to be used in the treatment of as many as 500,000 new patients with cancer per year.1

The survey conducted by the NCCN Best Practices Committee features answers from 27 NCCN Member Institutions serving patients with cancer across the United States. According to their results, 93% of the centers are currently experiencing a shortage of carboplatin, and 70% have a similar lack of cisplatin.

According to the survey, which ran May 23–31, 2023, 100% of the centers are still able to treat patients who need cisplatin without any delays or claim denials. However, for carboplatin, that number drops to only 64% of centers that are able to keep all current patients on the regimen. Another 20% report being able to continue this prescription for some but not all patients. Overall, 16% report treatment delays as a result of needing to reobtain prior authorization for modified treatment plans, but none have met outright denials.

“These results demonstrate the widespread impact of the chemotherapy shortage,” said Alyssa Schatz, MSW, Senior Director, Policy and Advocacy, NCCN. “We hope that by sharing this survey and calling for united action across the oncology community, we can come together to prevent future drug shortages and ensure quality, effective, equitable, and accessible cancer care for all.”

The survey revealed that 40% of centers have received information from manufacturers and suppliers on when availability for carboplatin and cisplatin should resume.

Visit NCCN.org/platinum-statement to view the full statement and NCCN.org/platinum-survey for the survey results.

Reference

1.

Goldberg P. Richard Pazdur discusses root causes of cisplatin and carboplatin shortage and what can be done to alleviate it. Accessed July 1, 2023. Available at: https://cancerletter.com/conversation-with-the-cancer-letter/20230530_1/

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NCCN Debuts Roadmap for Improving Thyroid Cancer Care in Low- and Middle-Income Countries on World Stage

NCCN introduced a new global resource to improve thyroid cancer care in low- and middle-income countries at the World Congress on Thyroid Cancer in London. During the event, NCCN Senior Vice President and Chief Medical Officer, Wui-Jin Koh, MD, presented on NCCN’s ongoing global work to define and advance high-quality, high-value, patient-centered cancer care. As part of that work, the nonprofit alliance of leading cancer centers recently published the new NCCN Framework for Resource Stratification of NCCN Guidelines (NCCN Framework) for Thyroid Carcinoma, available free-of-charge at NCCN.org/global. The new resource debuted in front of more than 1,000 cancer care providers from across the globe on June 17, 2023.

The NCCN Framework exists for numerous cancer types, covering >80% of cancer diagnoses, in addition to supportive care topics such as pain management, palliative care, and breast cancer prevention and detection. The NCCN Framework for Thyroid Carcinoma is the first new cancer type to be added to this library in recent years. More than 500,000 people are diagnosed with thyroid cancer worldwide every year.1 The NCCN Framework for Thyroid Carcinoma provides guidance on the optimal treatment approach for differentiated thyroid cancers in resource-constrained settings.

“The NCCN Framework establishes a realistic baseline of care tailored to various resource levels. It also showcases which future investments could be most effective,” said Robert W. Carlson, MD, Chief Executive Officer, NCCN. “These tools represent NCCN’s longstanding commitment to improving equity and outcomes for people with cancer, no matter where they live. More than 800,000 registered users outside the United States rely on the NCCN Guidelines to provide the latest evidence-based expert consensus cancer treatment recommendations. We want to make sure we’re providing accessible advice which improves outcomes for everyone.”

“The state-of-the-art NCCN Guidelines are widely used and respected worldwide—but the full recommendations aren’t always feasible in lower-resource settings,” said World Congress on Thyroid Cancer President Gregory W. Randolph, MD, FACS, FACE, FEBS (Endocrine), MAMSE, Professor of Otolaryngology Head and Neck Surgery, Claire and John Bertucci Endowed Chair in Thyroid Surgical Oncology, Harvard Medical School. “The World Congress on Thyroid Cancer brings together hundreds of care providers from all around the world. This year, instead of just talking about the inapplicability of guidelines intended for high-resource environments, we’re introducing a solution…the new NCCN Framework for Thyroid Carcinoma. We feel this represents a global solution to thyroid cancer guidelines. The World Congress on Thyroid Cancer has forged a relationship that has been so gratifying and positive, we’re committed to keep working with NCCN going forward.”

The NCCN Framework stratify the gold-standard recommendations from the NCCN Guidelines into 3 different resource levels (Basic, Core, and Enhanced). The recommendations at each level are color-coded so that the resource stratified recommendations can be viewed within the context of the NCCN Guidelines. The NCCN Framework resources are defined as follows:

  • • Basic resources: Essential services needed to provide basic minimal standard of care.

  • • Core resources: Includes services provided in the Framework for Basic Resources plus additional services that provide major improvements in disease outcomes (eg, survival) that are not cost-prohibitive.

  • • Enhanced resources: Services provided in the Framework for Core Resources and additional services that provide lesser improvements in disease outcomes and/or services that provide major improvements in disease outcomes but are cost-prohibitive in lower-resource settings.

Robert I. Haddad, MD, Division Chief, Center for Head and Neck Oncology, Dana-Farber Cancer Institute, and Professor of Medicine, Harvard Medical School, is the Chair of the multidisciplinary panel of experts from across NCCN’s Member Institutions responsible for updating and maintaining the NCCN Guidelines for Thyroid Carcinoma. He also took a lead role in creating the NCCN Framework for Thyroid Carcinoma and joined Dr. Koh at the World Congress to present this new resource.

“We analyze all of the available evidence and review it with our colleagues and fellow panel members at least once a year, and sometimes more often, to make sure the NCCN Guidelines reflect the very latest research and best practices,” said Dr. Haddad. “In the process of developing this NCCN Framework, we worked with the World Congress on Thyroid Cancer to solicit feedback from all over the world. We really appreciate everyone’s efforts helping us set standards for optimally tailoring resource-stratified recommendations to maximally benefit all people with thyroid cancer globally.”

NCCN currently has more than 250 translations of clinical resources across 69 languages in addition to NCCN International Adaptations and NCCN Harmonized Guidelines (which are similar to NCCN Framework but created for specific regions in joint efforts with local experts). View these free resources and learn more about NCCN’s collaborative work to define and advance high-quality, high-value, patient-centered cancer care globally at NCCN.org/global.

Reference

1.

Pizzato M, Li M, Vignat J, et al. The epidemiological landscape of thyroid cancer worldwide: GLOBOCAN estimates for incidence and morality rates in 2020. Lancet Diabetes Endocrinol 2022;10:264272.

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NCCN Convenes Policy Summit Assessing Impact of Geography on Cancer Outcomes, Examining Rural and Urban Divide

NCCN—an alliance of leading cancer centers—convened a policy summit to examine how geography impacts cancer outcomes. NCCN Chief Executive Officer, Robert W. Carlson, MD, opened the event with a focus on equity.

“NCCN’s work is guided by the idea that where you live should not impact whether you live,” said Dr. Carlson. “NCCN Guidelines are one free resource to make sure everyone, everywhere, has access to cancer care based on the latest evidence and expert consensus. They can be used as guardrails to standardize treatment—preventing under- or overtreatment—while still enabling freedom for personalized care.”

Advocates, providers, lawmakers, and others shared diverse perspectives on how location, policies, culture, and built environment can all impact cancer incidences and outcomes.

“Broadly, ‘built environment’ refers to all human-made surroundings, and includes various cancer-relevant factors, such as reliable internet access; accessible high-quality cancer care and public transportation; level and continuous sidewalks; nearby parks and recreational facilities, nutritious foods, and tree cover; clean air and water; and safe and supportive housing and neighborhoods,” explained panel member Jesse John Plascak, PhD, MPH, Assistant Professor, Division of Cancer Prevention & Control, The Ohio State University Comprehensive Cancer Center – James Cancer Hospital and Solove Research Institute. “Investing in improving the built environment translates to better health outcomes, including cancer.”

The program featured a fireside chat with Congressman Brian Higgins (NY-26), who shared an overview of the policy landscape and a look at how different regions can be better served.

“Early detection is our best protection against cancer of all types, but many Americans, especially those living in underserved communities, lack access to regular screenings, which puts them at a greater risk,” said Congressman Higgins. “As Co-Chair of the Cancer Caucus in the U.S. House of Representatives, I am committed to advancing efforts that address equity in cancer care, improve access to routine screenings, and increase funding leading to breakthroughs and advancements in treatments. Together, we can reach the communities in greatest need and achieve the goals set forth by President Biden’s Cancer Moonshot to end cancer as we know it.”

Elisa Rodriguez, PhD, MS, Vice President & Associate Director of Diversity, Equity and Inclusion (DEI), Roswell Park Comprehensive Cancer Center, provided the keynote address.

“Our nation’s cancer centers are uniquely positioned to address cancer health disparities and inequity in access to cancer services,” noted Dr. Rodriguez, who also serves as Director, Community Engagement Resource for Roswell Park and is a member of the NCCN DEI Directors Forum. “The populations and regions we serve are diverse in many ways—they are rural, urban, and suburban, and the people living in these distinct geographic regions reflect every dimension of humanity and need. Our experiences at Roswell Park can serve as a model for how cancer centers can enlist partners in their work to enhance infrastructure and develop effective strategies to address the cancer burden, increasing access to cancer care for all patients.”

There was a focus on the rural/urban divide throughout the summit, with speakers identifying how various regions can face very different challenges which require thoughtful solutions. They noted that cancer incidence rates tend to be higher in urban areas, but mortality rates are higher in rural communities. In urban areas, there may be more environmental and behavioral stressors contributing to cancer incidences, such as less access to safe places for physical activity or affordable fruits and vegetables. In rural areas, there are numerous barriers to accessing medical care providers—particularly specialists—including staffing shortages and transportation concerns.

“Access to innovative oncology treatments and clinical trials for patients—regardless of where they live—has long been a challenge in oncology and clinical development,” said Sara Kulwicki, MS, Associate Vice President, Clinical Development—Oncology Clinical Design, Delivery & Analytics, Lilly. “In addition to barriers that exist for all patients, those in rural areas face increased obstacles to receiving optimal care. We must continue educating, advocating, and deploying solutions that remove financial, transportation, and other barriers, bringing care closer to patients.”

“A substantial number of rural patients often prefer or need to receive cancer care locally, yet many community hospitals are too under-resourced to offer the continuum of comprehensive and supportive cancer services included in evidence-based standards of care,” agreed Mary Charlton, PhD, Associate Professor, Department of Epidemiology, The University of Iowa, and Director, Iowa Cancer Registry. “In order to provide quality care across varying locales, we must develop a multifaceted, collaborative cancer network approach that extends the resources and expertise from larger cancer centers out to rural hospitals and providers. This must be done in a way that capitalizes on everyone’s strengths while fostering trust and engagement between providers. This strategy has worked well in states like Kentucky and Kansas, and our research aims to develop a rigorous implementation strategy to adapt these network approaches throughout rural America.”

The speakers offered many insights on leveraging technology to serve more patients. They acknowledged the massive expansion in telehealth was one positive thing to come from the COVID-19 pandemic. However, panel members pointed out that there is still more work to be done to harness technology effectively and equitably. Speakers also spotlighted how interpersonal interactions play an outsized role in finding solutions for the many challenges that prevent rural patients from getting high-quality care.

“The key to delivering specialized cancer care to rural patients is to make that care accessible through a multifaceted approach, collaborating with community oncologists and primary care providers with bidirectional trust and communication,” commented Ursa Brown-Glaberman, MD, Associate Professor, Hematology/Oncology, Medical Director, Clinical Research Office, University of New Mexico Comprehensive Cancer Center.

“While issues of policy, technology, and geography are important, we can’t forget that a community’s culture must be considered and understood when working to increase access to cancer screenings and treatments,” agreed Keith Argenbright, MD, Director, Moncrief Cancer Institute, UT Southwestern Harold C. Simmons Comprehensive Cancer Center. “We must always keep in mind the cultural differences that make our targeted populations unique, and work to create policies and partnerships that are embraced by those communities.”

Alma McCormick, BS in Health and Human Performance, Health and Wellness, Executive Director, Messengers for Health, Crow Nation, and Member, PCORI Advisory Panel on Patient Engagement, shared stories of successful community-based participatory research addressing the cancer needs among Crow Indian people. She had a suggestion for one way to gain trust in marginalized communities: “Do what you say you are going to do.”

She continued: “Go to where the people are and let them know you care.”

International head-and-neck expert Waleed Mourad, MD, Professor of Radiation Oncology, Medical Director, Morehead Cancer Center, The University of Kentucky, is doing exactly that on a global scale. Dr. Mourad is both the radiation oncology physician founder of sub-Saharan Cameroon Oncology Cancer Center and the current medical director of an academic rural practice in Appalachia. He discussed the A-to-Z challenges of ground up establishment of a cancer treatment facility as well as ongoing challenges in prevention, screening, diagnosis, treatment, and surveillance in both settings.

“Working toward the World Cancer Day goal to ‘Close the Care Gap’ takes a village,” said Dr. Mourad. “With the increased globalization of society, we are all citizens of the world. I cannot underscore enough how important it is to address and mitigate care gaps by delivering culturally appropriate, team-oriented, competent care.”

Panelists Mei Wa Kwong, JD, Executive Director, Center for Connected Health Policy; Janette Merrill, MS Ed, Senior Director, Policy Programs, ASCO; and Joette Walters, MSN, MBA, RN, Chief Executive Officer, Tuba City Regional Health Care Corporation, Navajo Nation, also made key contributions to the program. The panel discussions were moderated by Clifford Goodman, PhD, and closing remarks were provided by NCCN Chief Operating Officer Gary Weyhmuller, MBA, SPHR.

The next NCCN Policy Summit will be held on September 12, 2023, with a focus on measuring and addressing health-related social needs in cancer. The event will include the launch of a high-impact screening tool to help healthcare providers meet patient needs and provide better care. Visit NCCN.org/summits to learn more and register.

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  • 1.

    Goldberg P. Richard Pazdur discusses root causes of cisplatin and carboplatin shortage and what can be done to alleviate it. Accessed July 1, 2023. Available at: https://cancerletter.com/conversation-with-the-cancer-letter/20230530_1/

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 1.

    Pizzato M, Li M, Vignat J, et al. The epidemiological landscape of thyroid cancer worldwide: GLOBOCAN estimates for incidence and morality rates in 2020. Lancet Diabetes Endocrinol 2022;10:264272.

    • PubMed
    • Search Google Scholar
    • Export Citation
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