Criteria Described to Allocate Scarce Drugs for Pediatric Oncology Patients

A framework has been issued to avoid waste and guide difficult prioritization decisions among children who need scarce life-saving chemotherapy treatment. This commentary, written by experts in pediatric oncology and bioethics who explained that clinicians lack allocation guidance, was published in JNCI: Journal of the National Cancer Institute.1

"Physicians and administrators faced with having to decide which of 2 children with cancer receives a scarce life-saving treatment need guidance and should not feel that they are on their own without a roadmap," said lead author of the commentary Yoram Unguru, MD, MA, MS, a pediatric hematologist/oncologist at The Herman and Walter Samuelson Children's Hospital at Sinai and a faculty member of the Johns Hopkins Berman Institute of Bioethics.

Since evidence-based recommendations are absent, these experts shared a modified utilitarian model that maximizes total benefit from the available supply of drug. The model also seeks to respect limited constraints on differential treatment of individuals. 

"In the absence of a much-needed national advisory statement on how best to allocate scarce drugs, and until policymakers and stakeholders can prevent future shortages, the guidance articulated here supports reasoned decision-making in the face of an actual drug shortage and aims to minimize bias as might occur when individual clinicians or institutions are forced to make difficult, and at times tragic, rationing decisions for children with cancer," the commentary stated.

Curability, prognosis, and the incremental importance of a particular drug to a given patient's outcome are the 3 critical factors proposed to determine allocation of scarce life-saving drugs.

The framework offers strategies to maximize efficiency and minimize waste. These include not over-ordering, or hoarding, drugs, and sending a patient to another institution if the drug is available there, rather than altering a treatment regimen.

Drug shortages should be treated like natural disasters at a policy level. This would raise public awareness and may lead to policy change and remediation.

"The context of allocation is always complex, but it is unethical to leave these challenges unaddressed.  It is our hope that this framework will be helpful and spur further substantive action on this crucial issue," Dr Unguru said.

Reference

1. Unguru Y, Fernandez CV, Bernhardt B, et al. An ethical framework for allocating scarce life-saving chemotherapy and supportive care drugs for childhood cancer. J Natl Cancer Inst. 2016;108(6).

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