Every academic cancer center that answered the latest National Comprehensive Cancer Network survey reported a shortage of at least one anticancer drug, and more than 20% were short of five or more medications at once. Buried in the same results is a figure that describes a much larger group of patients: 77% of those centers said they were aware of shortage problems at community oncology practices in their own region.
That number points outside the survey's own sample. NCCN polled its member institutions, which are large academic centers with dedicated pharmacy departments, buying leverage and staff whose job is to manage supply. The practices they were describing are the neighborhood infusion centers, hospital-affiliated clinics and rural hospitals where most Americans actually receive chemotherapy.
For a family choosing where to be treated, or already being treated close to home, that gap is the practical part of this story. A shortage that a major center absorbs through pooling partial vials and reworking schedules can become a delayed cycle or a substituted regimen at a smaller practice with no inventory cushion.
The Buying Power Gap Behind Uneven Access
Oncology leaders have described the mechanism plainly in the medical literature. Writing in JCO Oncology Practice, Jason Westin and colleagues noted that hospitals and large health systems can procure larger supplies, while smaller clinics and community treatment centers more commonly order medications just in time for specific patients. A supply disruption therefore lands harder on those smaller entities.
Transferring drug between institutions is not a simple fix. The authors described regulatory and logistical barriers to moving product between facilities, and noted that larger groups may prioritize their own patients during a prolonged shortage. The consequence they identified is geographic: patients in rural communities may be pushed to travel long distances to a different facility, which is often not feasible.
A separate commentary published by CancerNetwork made the equity point directly, arguing that a national solution cannot simply shift scarce drugs toward the institutions best positioned to obtain them, and that reliable access should not depend on where a patient lives or receives treatment.
Research inside community practices supports the concern. A study of community oncology research practices, covering 96 sites in the National Cancer Institute Community Oncology Research Program, measured how often practices encountered care delivery problems from shortages, defined as switching to less effective treatments, adopting more toxic alternatives, treatment delays, or an increase in medication errors and near misses.
The Drugs in Short Supply Are the Backbone Ones
The current shortage list is dominated by old generic injectables rather than newer branded therapies. Ifosfamide was short at 94% of responding centers, carboplatin at 71%, and cisplatin at 16%, with BCG for bladder cancer short at more than half, according to NCCN's announcement of the latest shortage survey.
These are not marginal drugs. Ifosfamide alone is used against bladder, ovarian, testicular and uterine cancers, soft tissue sarcoma, osteosarcoma, and several adult and pediatric leukemias and lymphomas. It has no direct therapeutic substitute, which removes the usual option of switching within a drug class. Carboplatin and cisplatin are the backbone of regimens for numerous tumor types.
The economics are the reason the problem keeps returning. NCCN policy vice president Alyssa Schatz quoted one surveyed pharmacy director who wrote that "many oncology generics are clinically indispensable but economically unattractive. Without correcting that economic imbalance, shortages are likely to recur." Asked whether national or state policy had changed the situation since 2023, 96% of pharmacy directors said it had stayed about the same and 4% said it had improved.
Questions That Change the Answer at a Local Clinic
Patients treated at a community practice can ask a different set of questions than those handed out for academic centers. The first is whether the clinic holds inventory or orders per patient, because that determines how much warning exists before a cycle is affected.
The second is whether the practice is part of a larger health system or purchasing group, and whether it can draw on that system's supply. The third is what the backup plan is if a specific drug is unavailable on the scheduled date, including whether treatment at an affiliated site is possible and who arranges it.
Insurance is the step most likely to create a delay even when a drug is found. NCCN reported that when a treatment plan had to be modified because of a shortage, 90% of centers needed some form of repeat prior authorization, which adds work per patient and creates the potential for delays. Asking the clinic to start prior authorization early, before a substitution is finalized, is the single most useful administrative move.
Patients should not skip, delay or alter treatment on their own, and should avoid buying cancer drugs from unverified online sellers. Anyone enrolled in a clinical trial should ask the research team specifically whether study drug supply is affected, since 39% of surveyed centers said shortages had touched their trials.
Cost and travel deserve a separate conversation. If a substitution or a transfer to another site is proposed, it is reasonable to ask what the patient's share of the cost would be at each location, whether transportation assistance exists, and whether a hospital financial counselor can review the change before it happens. Many cancer centers and drug manufacturers run patient assistance programs, and a navigator can identify which ones apply.
MedicalDaily previously reported on the survey's headline findings and what patients should ask, and on the FDA's temporary authorization of imported ifosfamide made for the Chinese market.
What remains unknown is how many community practices are currently unable to obtain these drugs, because no national survey measures them the way NCCN measures its own members. Federal shortage listings track manufacturer supply, not clinic-level availability. Until that gap is closed, the most reliable information for a household is the answer their own clinic gives when asked directly.
Key Questions Answered
Does this mean community clinics are running out of chemotherapy? Not necessarily. It means they typically have less inventory cushion and less purchasing leverage, so the same national shortage reaches them differently.
Which drugs are affected? Mainly older generic injectables, led by ifosfamide, carboplatin and cisplatin, plus BCG for bladder cancer. Newer branded therapies are largely not involved.
Why is ifosfamide the biggest problem? NCCN and oncology groups say no direct therapeutic substitute exists, so clinicians cannot switch within the drug class the way they sometimes can with platinum agents.
Should a patient transfer to a larger center? That is a conversation for the treating oncologist. Travel, cost, and continuity of care all matter, and a transfer is not automatically better.
What should someone ask their clinic? Whether their regimen includes a drug in shortage, whether the clinic holds inventory, what the backup plan is, and whether a change would need new insurance approval.
Does a regimen change affect insurance? Often yes. Ninety percent of surveyed centers reported needing repeat prior authorization after a shortage-driven change.
Are clinical trials affected? Some are. Thirty-nine percent of surveyed centers reported shortages affecting trials. Participants should ask their research coordinator about study drug supply.
