{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T15:40:28Z","timestamp":1792424428152,"version":"4.5.0"},"reference-count":22,"publisher":"American Medical Association (AMA)","issue":"10","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n Cancer drug shortages require health systems to rapidly develop and enact allocation policies, yet little is known about how such policies perform in practice.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To evaluate clinical implementation of a formal allocation policy during the 2023 carboplatin shortage.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This cohort study comprised a carboplatin shortage at a 7-site health system in Massachusetts and New Hampshire that lasted from June 1 to July 17, 2023. Patients with cancer who were eligible for carboplatin during the shortage were assigned priority categories using predetermined criteria based on treatment intent, inferior or contraindicated alternative treatments, clinical trial participation, and ongoing vs new treatment; these categories were assigned collectively by clinical groups and disease-specific pharmacists after a training session. A structured process conducted between September and November 2025 was used to review medical records and independently reassign categories post hoc.<\/jats:p>\n <\/jats:sec>\n \n Exposure<\/jats:title>\n Allocation of carboplatin during the shortage vs mandate to switch to an alternative treatment.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n Main outcomes were concordance between actual and review-based priority category assignments, actual allocation, and independent review\u2013based allocation, as well as associations of demographic and clinical variables with allocation. Descriptive statistics and multivariable logistic regression assessed actual and review-based outcomes.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Allocation decisions were made for 483 patients (median age, 66 years [IQR, 58-73 years]; 354 women [73%]). A total of 222 patients (46%) were allocated carboplatin and 261 (54%) were not. An independent review agreed with 56% of priority category assignments (189 of 335) and 74% of allocation decisions (357 of 483); 26% of allocation decisions (126 of 483) were not aligned with policy intent. Incomplete documentation (51% [74 of 146]) and treatment contraindication discrepancies (21% [31 of 146]) were the most common causes of disagreement. In multivariable regression, male gender (vs female gender; odds ratio [OR], 2.72 [95% CI, 1.26-5.99];\n P<\/jats:italic>\n \u2009=\u2009.01) and treatment at main campus (vs regional campuses; OR, 2.13 [95% CI, 1.30-3.45];\n P<\/jats:italic>\n \u2009&amp;lt;\u2009.001) were associated with increased likelihood of receiving carboplatin. In models of policy-concordant allocation based on independent review, these associations were not significant (male gender: OR, 1.39 [95% CI, 0.16-13.08];\n P<\/jats:italic>\n \u2009=\u2009.77; treatment at main campus: OR, 1.47 [95% CI, 0.33-7.14];\n P<\/jats:italic>\n \u2009=\u2009.61).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n In this cohort study of allocation policy implementation during a chemotherapy shortage, most allocation decisions aligned with policy intent, but key implementation gaps were identified and may have been associated with biases in allocation. Explicit documentation, contemporaneous monitoring, and enforcement mechanisms may improve policy implementation during oncology drug shortages.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2026.33164","type":"journal-article","created":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T15:00:30Z","timestamp":1792422030000},"page":"e2633164","source":"Crossref","is-referenced-by-count":0,"title":["Allocation Policy Implementation During a Severe Chemotherapy Shortage"],"prefix":"10.1001","volume":"9","author":[{"given":"Eric C.","family":"Blackstone","sequence":"first","affiliation":[{"name":"Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts"},{"name":"Center for Bioethics, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yating","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eno-Abasi","family":"Inyang","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Dana-Farber Cancer Institute, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew G.","family":"Shuman","sequence":"additional","affiliation":[{"name":"Michigan Bioethics, University of Michigan Medical School, Ann Arbor"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Casey","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregory A.","family":"Abel","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts"},{"name":"Center for Bioethics, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Hantel","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts"},{"name":"Center for Bioethics, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","published-online":{"date-parts":[[2026,10,19]]},"reference":[{"issue":"4","key":"zoi260908r1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2024.4246","article-title":"Drug shortages prior to and during the COVID-19 pandemic.","volume":"7","author":"Callaway Kim","year":"2024","journal-title":"JAMA Netw Open"},{"issue":"5","key":"zoi260908r2","doi-asserted-by":"publisher","DOI":"10.1097\/PPO.0000000000000786","article-title":"Mitigating the impact of drug shortages in oncology: lessons learned from the 2023 shortages of carboplatin and cisplatin.","volume":"31","author":"Izen","year":"2025","journal-title":"Cancer J"},{"issue":"5","key":"zoi260908r3","doi-asserted-by":"publisher","first-page":"834","DOI":"10.1200\/OP-25-00057","article-title":"Impact of drug shortages on cancer care delivery within the National Cancer Institute Community Oncology Research Program.","volume":"22","author":"Ghazal","year":"2026","journal-title":"JCO Oncol Pract"},{"issue":"5","key":"zoi260908r4","doi-asserted-by":"publisher","first-page":"710","DOI":"10.1001\/jamainternmed.2018.8251","article-title":"Prevalence and severity of rationing during drug shortages: a national survey of health system pharmacists.","volume":"179","author":"Hantel","year":"2019","journal-title":"JAMA Intern Med"},{"issue":"9661","key":"zoi260908r5","doi-asserted-by":"publisher","first-page":"423","DOI":"10.1016\/S0140-6736(09)60137-9","article-title":"Principles for allocation of scarce medical interventions.","volume":"373","author":"Persad","year":"2009","journal-title":"Lancet"},{"issue":"21","key":"zoi260908r6","doi-asserted-by":"publisher","first-page":"2049","DOI":"10.1056\/NEJMsb2005114","article-title":"Fair allocation of scarce medical resources in the time of COVID-19.","volume":"382","author":"Emanuel","year":"2020","journal-title":"N Engl J Med"},{"issue":"3","key":"zoi260908r7","doi-asserted-by":"publisher","first-page":"358","DOI":"10.1200\/JCO.23.01941","article-title":"ASCO ethical guidance for the practical management of oncology drug shortages.","volume":"42","author":"Hantel","year":"2024","journal-title":"J Clin Oncol"},{"issue":"2","key":"zoi260908r8","doi-asserted-by":"publisher","first-page":"102","DOI":"10.1086\/JCE201425203","article-title":"A protocol and ethical framework for the distribution of rationed chemotherapy.","volume":"25","author":"Hantel","year":"2014","journal-title":"J Clin Ethics"},{"issue":"7","key":"zoi260908r10","doi-asserted-by":"publisher","first-page":"727","DOI":"10.1016\/S1470-2045(23)00289-9","article-title":"Cancer care critically affected by USA drug shortages.","volume":"24","author":"Gourd","year":"2023","journal-title":"Lancet Oncol"},{"issue":"12","key":"zoi260908r11","doi-asserted-by":"publisher","first-page":"1538","DOI":"10.1001\/jamaoncol.2025.3768","article-title":"Nationwide response to carboplatin and cisplatin shortages in lung cancer.","volume":"11","author":"Lin","year":"2025","journal-title":"JAMA Oncol"},{"issue":"6","key":"zoi260908r12","doi-asserted-by":"publisher","first-page":"1276","DOI":"10.1093\/jnci\/djae307","article-title":"Real-world impact of the platinum chemotherapy shortage on US patients with advanced cancer.","volume":"117","author":"Reibel","year":"2025","journal-title":"J Natl Cancer Inst"},{"issue":"1","key":"zoi260908r13","doi-asserted-by":"publisher","first-page":"19","DOI":"10.1200\/OP.23.00545","article-title":"Drug shortages in oncology: ASCO clinical guidance for alternative treatments.","volume":"20","author":"Santos","year":"2024","journal-title":"JCO Oncol Pract"},{"issue":"16","key":"zoi260908r15","doi-asserted-by":"publisher","first-page":"2409","DOI":"10.1002\/sim.1047","article-title":"A solution to the problem of separation in logistic regression.","volume":"21","author":"Heinze","year":"2002","journal-title":"Stat Med"},{"issue":"4","key":"zoi260908r16","doi-asserted-by":"publisher","first-page":"334","DOI":"10.1634\/theoncologist.2019-0910","article-title":"When pigs fly: a multidisciplinary approach to navigating a critical heparin shortage.","volume":"25","author":"Rosovsky","year":"2020","journal-title":"Oncologist"},{"issue":"4","key":"zoi260908r17","doi-asserted-by":"publisher","DOI":"10.1097\/JHQ.0000000000000484","article-title":"Navigating an intravenous fluid shortage crisis: a health system\u2019s response to a hurricane-induced supply disruption.","volume":"47","author":"Nahass","year":"2025","journal-title":"J Healthc Qual"},{"issue":"4","key":"zoi260908r18","doi-asserted-by":"publisher","DOI":"10.1002\/pbc.30871","article-title":"Implementation of a tier system for IVIG indications to address IVIG shortage at a tertiary care pediatric medical center.","volume":"71","author":"Roth","year":"2024","journal-title":"Pediatr Blood Cancer"},{"issue":"14","key":"zoi260908r22","doi-asserted-by":"publisher","first-page":"1433","DOI":"10.1001\/jama.2017.2841","article-title":"Association between US norepinephrine shortage and mortality among patients with septic shock.","volume":"317","author":"Vail","year":"2017","journal-title":"JAMA"},{"key":"zoi260908r9","doi-asserted-by":"crossref","DOI":"10.1093\/acprof:oso\/9780195149364.001.0001","volume-title":"Setting Limits Fairly: Can We Learn to Share Medical Resources?","author":"Daniels","year":"2002"},{"key":"zoi260908r14","unstructured":"Treatment by cancer type: NCCN guidelines. National Comprehensive Cancer Network. Accessed September 1, 2025. https:\/\/www.nccn.org\/guidelines\/category_1"},{"key":"zoi260908r19","unstructured":"Short supply: the health and national security risks of drug shortages. United States Senate Committee on Homeland Security & Governmental Affairs. March 2023. Accessed March 10, 2026. https:\/\/www.hsgac.senate.gov\/wp-content\/uploads\/2023-06-06-HSGAC-Majority-Draft-Drug-Shortages-Report.-FINAL-CORRECTED.pdf"},{"key":"zoi260908r20","unstructured":"Drug shortages: root causes and potential solutions. US Food & Drug Administration. March 11, 2020. Accessed March 10, 2026. https:\/\/www.fda.gov\/drugs\/drug-shortages\/report-drug-shortages-root-causes-and-potential-solutions"},{"key":"zoi260908r21","unstructured":"Jewett? C. Shortage of chemotherapy drugs brings rationing fears. New York Times. June 24, 2026. Accessed July 1, 2026. https:\/\/www.nytimes.com\/2026\/06\/24\/health\/chemotherapy-drug-shortage.html"}],"container-title":["JAMA Network Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/articlepdf\/2855478\/blackstone_2026_oi_260908_1791821848.60269.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T15:00:32Z","timestamp":1792422032000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/fullarticle\/2855478"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,19]]},"references-count":22,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2026,10,1]]}},"URL":"https:\/\/doi.org\/10.1001\/jamanetworkopen.2026.33164","relation":{},"ISSN":["2574-3805"],"issn-type":[{"value":"2574-3805","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,19]]}}}