An Ethical Framework for Allocating Scarce Life-Saving Chemotherapy and Supportive Care Drugs for Childhood Cancer

Yoram Unguru; Conrad V. Fernandez; Brooke Bernhardt; Stacey Berg; Kim Pyke-Grimm; Catherine Woodman; Steven Joffe

doi:10.1093/jnci/djv392

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An Ethical Framework for Allocating Scarce Life-Saving Chemotherapy and Supportive Care Drugs for Childhood Cancer

Journal article

Open access

Peer reviewed

An Ethical Framework for Allocating Scarce Life-Saving Chemotherapy and Supportive Care Drugs for Childhood Cancer

Yoram Unguru, Conrad V. Fernandez, Brooke Bernhardt, Stacey Berg, Kim Pyke-Grimm, Catherine Woodman and Steven Joffe

JNCI : Journal of the National Cancer Institute, Vol.108(6), pp.djv392-djv392

06/01/2016

DOI: 10.1093/jnci/djv392

PMID: 26825103

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Abstract

Shortages of life-saving chemotherapy and supportive care agents for children with cancer are frequent. These shortages directly affect patients' lives, compromise both standard of care therapies and clinical research, and create substantial ethical challenges. Efforts to prevent drug shortages have yet to gain traction, and existing prioritization frameworks lack concrete guidance clinicians need when faced with difficult prioritization decisions among equally deserving children with cancer. The ethical framework proposed in this Commentary is based upon multidisciplinary expert opinion, further strengthened by an independent panel of peer consultants. The two-step allocation process includes strategies to mitigate existing shortages by minimizing waste and addresses actual prioritization across and within diseases according to a modified utilitarian model that maximizes total benefit while respecting limited constraints on differential treatment of individuals. The framework provides reasoning for explicit decision-making in the face of an actual drug shortage. Moreover, it minimizes bias that might occur when individual clinicians or institutions are forced to make bedside rationing and prioritization decisions and addresses the challenge that individual clinicians face when confronted with bedside decisions regarding allocation. Whenever possible, allocation decisions should be supported by evidence-based recommendations. "Curability," prognosis, and the incremental importance of a particular drug to a given patient's outcome are the critical factors to consider when deciding how to allocate scarce life-saving cancer drugs.

Oncology

Life Sciences & Biomedicine

Science & Technology

Details

Title: Subtitle: An Ethical Framework for Allocating Scarce Life-Saving Chemotherapy and Supportive Care Drugs for Childhood Cancer
Creators: Yoram Unguru - Herman & Walter Samuelson Childrens Hosp Sinai, Div Pediat Hematol Oncol, 2401 W Belvedere Ave, Baltimore, MD 21215 USA
Conrad V. Fernandez - Dalhousie University
Brooke Bernhardt - Texas Childrens Hosp, Houston, TX 77030 USA
Stacey Berg - Baylor College of Medicine
Kim Pyke-Grimm - Lucile Packard Children's Hospital
Catherine Woodman - University of Iowa
Steven Joffe - University of Pennsylvania
Resource Type: Journal article
Publication Details: JNCI : Journal of the National Cancer Institute, Vol.108(6), pp.djv392-djv392
DOI: 10.1093/jnci/djv392
PMID: 26825103
NLM abbreviation: J Natl Cancer Inst
ISSN: 0027-8874
eISSN: 1460-2105
Publisher: Oxford University Press
Number of pages: 7
Language: English
Date published: 06/01/2016
Academic Unit: Psychiatry; Family and Community Medicine
Record Identifier: 9984296359702771

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