Voices: Teamwork combats bleomycin shortage

Teamwork combats bleomycin shortage | B.J. Rimel, MD

Two weeks ago my partner, Dr. Andrew Li, operated on a very young woman with a stage IV yolk sac tumor. We had discussed the chemotherapy regimen to give her and discussed the standard treatment of bleomycin, etoposide and cisplatin. Two days later we received and email from our pharmacy: “There is a national supply shortage of bleomycin. There is not enough drug at this hospital to start any new patients on regimens that contain this drug.”
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Don’t get me wrong, we have a great pharmacy here at Cedars-Sinai Medical Center and they are always watching out for us. But we’ve had a few more rare tumors this year and we simply don’t have enough drug right now. Dr. Li emailed me “What do I do for my patient?” My response was pretty weak. “Call the pharmacist, see if she’s on the list of people they were already counting on. If not, we can call around and see if someone else can help?”

I didn’t really think this would work.

But it did.

Dr. Li wrote an email sent to every gynecologic oncologist in the LA County area he knew and asked, “I have this patient who needs bleomycin. Can anyone help?”

His first email back was from Dr. Christine Holschneider at Olive View-UCLA Medical Center. She said, “Give me some more information. Let me see what I can do.” The next response was from Dr. Joshua Cohen at UCLA Westwood who was also willing to help, followed by Dr. Yevgenia Ioffe at Loma Linda. Ultimately Dr. Ioffe was able to secure the total amount of bleomycin for this patient and is going to treat her.

This is not “can I borrow a cup of sugar.” This is a big, messy, complicated, time-consuming activity for any of these doctors and their teams–especially for a patient they have never met. It’s also heartwarming, amazing, and something that goes deeper than a drug shortage.

This story made me think about how our most powerful tool in the care of our patients is often each other. I often think that I am simply the product of those who have gone before me and taught me to be a gynecologic oncologist either through hands-on fellowship training or through their work in science or clinical trials. A day does not go by that I don’t text or phone a gynecologic oncology buddy and ask a question about how to treat a particular patient or how to fix a surgical issue.

We are a small and fairly close knit group. Now as we have a shortage of a medicine that is critical to our patients with rare germ cell tumors I see another avenue to use our Society, our friends, to help us care for our patients. I encourage you to reach out to your gynecologic oncology colleagues if you have patients who need this medication. And write to your congressperson about working to end drug shortages, like this one, in the future. If you don’t have many gynecologic oncology friends–call me! I encourage you to consider social media to make contact (not to discuss patient related information) using the hashtag #bleomycin.