HSE takes steps to minimise chemotherapy delays

A shortage of chemotherapy drugs, which has delayed treatment for hundreds of cancer patients, has forced the Health Service Executive to make contingency plans to minimise the delays.

The number of patients experiencing delays in having chemotherapy administered may be as high as several hundred.

Most of the affected patients receive their medication in hospitals that do not have dedicated cancer units.

The contingency plans involve sending some patients to different hospitals for treatment, as well as sourcing other suppliers of chemotherapy drugs in Ireland and the UK.

The HSE said an unspecified number of patients had had their treatment delayed by a short period “in a small number of situations”.

It said contingency arrangements were in place to ensure patients received their chemotherapy in a timely manner and any delay would have no clinical impact on the treatment for patients.

“This is a fluid situation that changes from hospital to hospital and from day to day,” it said in a statement.

The supply difficulties have arisen since production equipment at Fannin Compounding, one of two companies supplying chemotherapy drugs to Irish hospitals, was taken out of use because of a contamination scare two weeks ago.

No patients suffered adverse effects due to the scare, but the isolator used to produce IV chemotherapy products remains out of commission.

The situation is complicated by the pending takeover of Fannin Compounding by US multinational Baxter Healthcare, the only other supplier of chemotherapy drugs here.

Three-quarters of chemotherapy products are made in compounding units within hospitals.

The rest are manufactured by Fannin Compounding and Baxter, along with some UK suppliers.

Acquisition cleared

The Competition and Consumer Protection Commission last week cleared the acquisition of Fannin Compounding by Baxter, despite finding it would result in a "significant reduction" in the commercial supply of chemotherapy products to hospitals in the State.

The two companies told the commission Fannin Compounding was a “failing division” and would leave the market any way if the acquisition did not go ahead.

The shortages are most acute in smaller hospitals that do not have dedicated compounding units and are reliant on commercial suppliers.

At Our Lady of Lourdes Hospital in Drogheda, a delay in the supply of some drugs for chemotherapy resulted in five patients having treatment postponed by a day, from Tuesday to Wednesday, last week.

In one case, it did not suit the patient to return for treatment on the Wednesday and they instead returned on Thursday, the HSE said.

“The hospital expressed its regret for the delay, which was outside its control.”

Patients referred

Delays were also experienced by a small number of patients at University Hospital Limerick.

Cancer patients requiring chemotherapy at Connolly hospital in Blanchardstown were sent instead to Beaumont Hospital, and plans were being made to refer patients at Portiuncula Hospital in Ballinasloe to other hospitals in the western region.

“Individual hospitals are working closely with the main supplier in Ireland and alternative suppliers in order to ensure a continuous and timely supply for their patients.

“Any distress that this situation is causing to patients is regrettable,” the HSE said.

Dr Jerome Coffey, director of the National Cancer Control Programme, said the HSE appreciated the anxiety caused by supply issues and the delay for some patients, but this delay was not "clinically disruptive".

He said hospitals had made every effort to guarantee supply since the issues arose at Fannin Compounding, but the challenge was to secure this long term. “We need some resilience in the system of supply,” he said.

Dr Coffey said hospitals with their own compounding units had increased output since the supply problems arose.

In addition, from next week, one commonly used cancer drug, 5FU, will be available in a standardised form known as “dose banding”, which is expected to further improve the supply situation.

Baxter said it was providing additional chemotherapy drugs in the short term “to help mitigate shortages which organisations may be currently experiencing”.

Fannin Compounding said it had communicated clearly with hospitals regarding its chemotherapy manufacturing capacity after the recent precautionary product recall.

The Health Products Regulatory Authority, which ordered the recall at Fannin Compounding on October 12th, said the isolator could not be used until it had reviewed the results of standard tests.

A second isolator was out of action since a separate recall in September.