Ethical dilemmas experienced by NCORP sites in managing drug shortages.

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50 Background: Drug shortages pose challenges to cancer care delivery, where treatment timelines and drug specificity are critical to achieving optimal patient outcomes. Oncology care involves coordination across multidisciplinary teams, and shortages can create cascading effects throughout the treatment pathway. This study identified prevalent barriers to drug shortage management across National Cancer Institute (NCI) National Community Oncology Research Program (NCORP) community oncology practices. Methods: This is a secondary, qualitative analysis of data from a baseline survey (URCC 18004CD; PI Hill) created in collaboration with economists, pharmacists, oncology clinicians, and cancer care delivery researchers. Data were drawn from responses by practices nationwide to an open-ended prompt: “What barriers does your practice experience for tracking and reporting drug shortage related impacts?” Responses were analyzed using a qualitative content analysis approach; barriers were coded, categorized, and synthesized into themes through consensus. Results: Of the 96 NCI NCORP practices that enrolled in the primary study and provided baseline data between December 2020-July 2024, 63 practices provided responses. Free text responses ranged from 31 to 609 characters. Five interconnected themes shaped barriers to effective drug shortage management: communication gaps; staffing constraints; supply chain instability; technology and system fragmentation; and patient impact (Table). Conclusions: Oncology drug shortage management is hindered by multifaceted yet interrelated barriers. These findings provide a foundation for targeted interventions and policy development to mitigate the impact of oncology drug shortages. Funding: UG1CA189961. Themes depicting barriers to effective drug shortage management among NCORP community practices. Theme Description Communication gaps · Inefficient and inconsistent communication across systems and stakeholders· Lack of timely updates from suppliers and regulatory bodies· No standardized protocols for notifying providers of shortages Staffing constraints · Limited staffing and time to manage shortages· Competing roles and overreliance on key individuals Supply chain instability · Unpredictable supply and delayed resupply· Limited storage and shifting procurement preferences Technology and system fragmentation · Disconnected systems (e.g., electronic health record and inventory systems) and limited tools for real-time tracking and reporting· Manual, reactive tracking with no centralized or automated systems· Fragmented, inaccessible, and delayed data across platforms Patient impact · Untracked treatment changes and unclear impact on patient outcomes· Unplanned patient volume and limited alternative therapies

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