Cancer drug shortages are forcing Canadian hospitals to scrounge for medication to avoid delaying treatment, CBC News has learned.

For weeks, hospitals and pharmacists across Canada and in the U.S. have struggled to cope with spot shortages for about five chemotherapy drugs. Many of the medications are decades-old, highly toxic cancer drugs that kill dividing cancer cells and are mainstays of cancer treatment.

Cancer patients may not get chemotherapy medicines on time or as planned. J. Scott Applewhite/Associated Press

"We have had to look at trying to reschedule some patients' treatments, and some people have been delayed by short periods of time," said Dr. Peter Ellis, a medical oncologist at the Juravinski Cancer Centre in Hamilton.

"Most [patients] were OK because they knew it was short term. I know of one patient who was particularly upset about the fact that they wouldn't get their treatment on time and they found out about that only when they turned up for treatment."

Ellis said they had no carboplatin — a drug used to treat ovarian, lung and other cancers — for days until pharmacists arranged to borrow some from another hospital.

Likewise, at Toronto's St. Michael's Hospital, five chemotherapy drugs are on back order. The drugs are being rationed by the supplier to hospitals across the region.

"In some disease states, it could be OK, but in other disease states, it could mean an inferior treatment for something that may not work as well and that could have a potential impact on their survival," said Kathy Vu, a clinical pharmacy practitioner at St. Michael's.

There are replacement options, but drugs of choice are preferred because they are either less toxic, easier to give, or have less risk of side-effects, said Dr. Gerald Batist, director of the Segal Cancer Centre at Montreal's Jewish General Hospital.

"This is the first time we have sort of a perfect storm and a few drugs, all at the same time for a prolonged period of time, are in back order," said Batist.

"In terms of the anti-tumour efficacy, we can find equivalents, but we'd like to give the patient the most state-of-the-art treatment and the best drugs," he said.

Call for registry

Hospital pharmacists are also using Health Canada's special access program to bring in drugs from the U.S., but the process involves more paperwork and extra costs, and applies only in exceptional cases.It is stressful for pharmacists to scramble to find chemotherapy drugs and face close calls with treating patients, says Kathy Vu, a clinical pharmacy practitioner at St. Michael's Hospital in Toronto. CBC

Doctors and pharmacists are clamouring for advance notice of shortages through a central registry, as exists in the U.S. A registry wouldn't solve the supply problems, but it would help hospitals to plan better, said Janice Wells, director of pharmacy at St. Michael's.

"The worst thing from a pharmacy standpoint is not knowing it's not coming," said Richard Jones of Medbuy, a company that works with hospitals to reduce the cost of health-care supplies. "If you have any kind of notice at all, it's a world of difference because we can make alternate decisions."

The sources of the supply problem are varied, including:

• Scarce raw ingredients.
• Manufacturing glitches.
• Reduced production or discontinuation of a drug.

Generic drug manufacturers such as Hospira and Teva, makers of carboplatin, are trying to help. Hospira said it is operating manufacturing plants around the clock to meet as much of the market demand as it can.

Manufacturing injectable drugs is complex and it is difficult to add production lines immediately, said Dan Rosenberg, senior manager of global public affairs for Illinois-based Hospira.

In a statement to CBC News, Teva Canada said it expects to be able to meet all Canadian requirements for carboplatin and another chemotherapy drug, vincristine, by the end of June.

Health Canada said it is aware of the shortages and "recognizes the impact these can have on patients and the people who care for them. Drugs are manufactured and sold by industry. Industry is responsible for understanding the supply needs of their products," a spokesperson said in an email.

With files from CBC's Kelly Crowe and Melanie Glanz