And yet, in recent years, when some hospital pharmacists have gone to source these chemo drugs for patients, they’ve had difficulty. They’ve had to call around, looking for some other facility that might have extra doses. Doctors, for their part, have had to have tough conversations with patients. If there’s no carboplatin or cisplatin to be had, patients might be given another, less-optimal chemotherapy. Or doctors might try spacing the doses out more than they usually would, trying to stretch the supply. Some fear that these shortages, which have been ongoing since 2023, might make cancer more deadly. In June, the U.S. Pharmacopeia, a nonprofit scientific group, released their latest report on drug shortages, which revealed that the average duration of shortages for drugs of all kinds has more than doubled since 2019.
This problem has been building for a while, says Matthew Christian, director of supply chain insights at U.S. Pharmacopeia. “Back in 2019, the average drug shortage only lasted about two years. But now when we look at the drugs that remain on the list, the average duration’s over five years,” he says. “In fact, 95% of drug shortages at the end of 2025 were holdovers from 2024. So current shortages—they're not new. It's old shortages that have not been resolved and show systemic issues in the supply chain.”
The market price is the problem. Hospitals in the U.S., or group-purchasing organizations working on their behalf, hunt for the least expensive sources of drugs. A manufacturer that offers the lowest price can win a contract to make a chemo drug. But the purchaser is under no obligation to guarantee that they will buy a given volume, which would ensure that the manufacturer will have enough money to continue making the drug, says Stefan Scholtes, a professor of health management at University of Cambridge in the U.K.
What’s more, the hunt for a minimal cost leads to factories overseas, to relatively few companies willing to take on the task, and to sourcing key ingredients and finished products from just a few places. This leads “to a very fragile supply chain, and when a little thing happens, the whole thing falls over,” says Scholtes. Some global shortages of chemotherapy drugs have been caused by a single plant going offline or failing a quality control check. Currently, the war in Iran has upended supply chains such that some of the few manufacturers of cisplatin and carboplatin are having trouble getting ingredients.
What’s the way forward?
At the moment, hospitals “are heavily incentivized to find any drug that is the cheapest upfront cost,” says Christian. “But there's no real mechanism for hospitals to pay more to ensure greater resilience.” As the shortages prove, these drugs aren’t products where market dynamics lead to a consistent, reliable manufacturing system. “They should be cheap and high-quality,” says Scholtes. “They are essential.”
Experts say that much more movement in this direction—–from contracts that hold buyers to purchasing a given volume, to factories closer to where drugs are needed, to more diversity and redundancy in supply chains—is needed before patients and doctors can feel secure that cancer care won’t be complicated by shortages. Reibel co-authored a paper looking at whether the 2023 shortage had changed cancer mortality rates, and while they found that doctors seem to have achieved similar short-term survival using alternative treatment plans, he points out that they need to look at the long term to get the full picture of the effects of these shortages.
“In oncology, any shortage in a single medication, a delay in treatment, or substitution could impact cure rates or even survival. So it’s immensely important that we have access to all the therapies at our disposal,” Reibel says. “Unless changes are made in the way that we create and procure these drugs, we will keep having shortages over and over again.”
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