Jack: Good evening and welcome.

Drug shortages have been making medications of all kinds difficult to get.

But now, vital chemotherapy drugs for cancer patients are also in short supply.

That is leaving hospitals and doctors with difficult decisions about how to treat their patients including the possibility of delaying treatment and rationing doses.

In New York, these kinds of shortages are taking a toll on patients and their physicians.

For a look at what is behind the shortages, how doctors are coping, and what might be done, we turn to Dr. Amanda Nicholas Feder.

She is a professor of gynecology at Johns Hopkins and the President-elect of the society of gynecologic oncology.

Thank you for joining us.

>> thank you for having me.

Jack: Let's start with a couple of big picture questions and we will get the specifics.

To set the stage, give us a sense of just how widespread these shortages are.

>> To put things in perspective, the issue of drug shortages is a chronic problem that has existed for more than a decade.

Specifically, specific -- generic drug shortages.

We know that drug shortages can occur for a variety of reasons, manufacturing or labor issues, quality control.

Inability to secure raw materials.

What is problematic that is happening in the current era is that we are seeing an increase in the number of drugs that are undergoing shortage.

In my field, oncology, life-saving chemotherapy drugs, we are seeing this class is often in the top five of drugs that are in consistent shortage in the United States.

This week, the FDA and the American Society of Hospital pharmacists report that we have 15 indispensable chemotherapy drugs that are in shortage.

Based on national surveys that have been conducted of oncologists and hospital systems , both from the society of oncology and the national network which is an alliance of centers across the U.S., this is a serious nationwide problem.

Through our survey, we found oncologists in more than 40 states and Washington, D.C. reported a shortage of at least one were more of these drugs in their institutions.

The national conference of can Prince that cancer services -- 93% were reporting a shortage of critical chemotherapy drugs.

Jack: For most people, this sounds counterintuitive.

I suspect, most people would think if you are talking about lifesaving drugs, they are going to be our priority.

Those are not the ones where we experience shortages.

Explain to us why, given this counterintuitive nature, why are these drugs that are so integral to saving lives, why are we seeing shortages?

Dr. Nickels: These are among the most important medicines and tools we use to stave lives.

The particular drugs that are in shortage are used in more than 100 different treatment regimens for adults and children from many different cancers from gynecologic cancers, uterine, cervix, breast, lung, prostate, testicular, bladder.

The list goes on.

It is a public health care crisis.

One of the reasons for that is that the most chemotherapy drugs that are in shortage are generic formulations.

Generic formulations are manufactured often by very few companies.

There's a lot of market instability with manufacturing of these drugs.

One of the reasons for that is that generic drugs do not bring in a lot of revenue for manufacturing companies.

And other facilities.

It is difficult for these organizations to invest in production of the drugs because they don't generate revenue.

The second reason is that there is a lot of market consolidation that has occurred, like because of the poor revenue stream.

You have very few companies around the world, sometimes just one or two, that produced the materials needed.

The active ingredients.

Or, one or two companies that are the primary manufacturer progress of the leading lifesaving chemotherapy drugs that we use to treat patients every day.

Jack: I want to give a couple of minutes to this question, what do we do?

Let's focus more on specifics for we are talking about dramatic shortages.

How are doctors responding to this in terms of day-to-day care and treatment?

Dr. Nickels: I can tell you that this is devastating for oncologists.

We live to help our patients live better lives.

Do not have access to some of the most important medicines is unacceptable.

It is even more devastating for patients.

It is a high-stakes for them.

There is a number of strategies we are using on the oncology side.

One of the initiatives I have been involved with, and other societies including the foundation for women's cancer, the American Society of clinical oncology and the gynecologic oncology foundation are working together to develop mitigation strategies.

Some of the things we are doing are looking at opportunities to preserve the drugs we have and get more mileage out of it for more patients.

We are using special pharmacy tech's that allow us to not waste a single drop of chemotherapy.

And use those drugs as responsibly as possible.

In order to do that, some of the things required include things like rounding the chemotherapy vials down to the nearest dose size.

If you have just a few drops in one file, you can add it to the next to treat the next patient.

These are critical strategies that pharmacies and oncologists are using.

We are developing alternative drug guidelines.

We are using best available evidence from rigorous chemical trials in order to develop recommendations for oncologists so that if one or more of -- these critical doubt -- if there is not a fantastic substitution available, we are creating new guidelines that will enable physicians to take care of patients in the best possible ways with other standards of care.

In many cases, the alternative substitutions recommended will be just as effective as the standard of care drugs that are in shortage, but there are trade-offs.

They have much more toxicity or side effects.

Sometimes permanent side effects.

We need to be thinking about that with our patients and that this is only a temporary strategy.

Jack: You mentioned how precarious the situation is.

I was going to ask about the consequences for patients but you have talked a lot about that.

Let's talk now about the consequences for physicians.

This is sort of a personal question.

This is what you do.

I mentioned before hand, this piece came about because I was having a conversation with my daughter, Dr. Ashley Haggerty, who has been on the program before and recommended I reach out to you.

She is that Hackensack Meridian Riverview.

Maybe anguish is too strong a word, but she was deeply concerned.

What are you suggesting to physicians, especially through the organization's, what are you saying to your members about how to handle this both professionally and personally?

Dr. Nickels: Thank you for asking.

While our patients are singular focused, their health and well-being we are passionate about.

I know for Dr. Ford Haggerty, the same thing.

We are devastated, but we are taking action.

We are creating better opportunities for patients during this tragedy than we could ever imagine.

On top of that, posting educational webinars for members to help them not only with developing oncology policies at their institutions, putting them in contact with foundations that may be able to help them get access to drugs if the manufacturers, if they do not have them available.

We are providing education and support to our members through webinars about how to have difficult conversations with patients for how to support your own wellness.

Having conversations no oncologists would ever want to have.

We have provided a private forum for our oncologists to talk about what is going on at the ground level and how we can best support them.

Similarly, the advocacy arm of this, the foundation for women's cancer led by Ginger Gardner, Memorial Sloan -- How do we support our patients through this?

How do we get the word out and help them get access, work with their local oncologists to receive the best care.

We also have an open survey we have submitted across patient advocate in the U.S. to understand what they are feelings -- with their feelings and thoughts are and how they can come to the table.

The third piece is advocacy.

The advocacy is with the FDA, directly with Capitol Hill legislators and drug manufacturers.

We want to have a seat at this table to develop long-term solutions so that this never happens again.

This is not sustainable.

Lives are going to be affected if we do not get a handle on this quickly.

Also, not just mitigate short-term, but look at long-term solutions as well.

Jack: You talked about what is being done now to prevent this from happening in the future.

Quickly, are you optimistic that in the short term we are making progress in terms of making these drugs more available?

Dr. Nickels: I am cautiously optimistic that we are starting to move in the right direction.

We still have a number of health care systems and patients across the country that are affected by the drug shortages, but drug supply of the key chemotherapy drugs in short supply are starting to trickle in.

Some manufacturers who went off-line due to quality control issues, one of the leading causes of the shortage, are now back online.

The FDA is working diligently on this for what they can control, including exploring and identifying sources of chemotherapy overseas for importation to the U.S. for emergency use.

That is going to be happening for at least one or two of the drugs that are in shortage.

Jack: Thank you so much.

Very informative.

Helping us understand the aspects of this critical issue.

And the progress we are hopefully going to be making.

Thank you for spending time with us and all the work you have been doing for your patience and the organization.

I look forward to talking to you soon to see how all of this is working out.

Dr. Nickels: Thank you.