Carboplatin Allocation Decisions Did Not Align With Health System Policy During Shortage

About one-quarter of carboplatin allocation decisions at a multisite cancer center during the 2023 shortage did not align with the center’s formal allocation policy, and gaps in implementation may have introduced bias, according to a cohort study published in JAMA Network Open.

The retrospective study examined Dana-Farber Cancer Institute’s allocation plan, used across 7 sites in Massachusetts and New Hampshire when carboplatin was rationed from June 1 to July 17, 2023. Clinical groups and pharmacists assigned eligible patients to priority categories 1 to 5 based on treatment intent, inferior or contraindicated alternatives, clinical trial participation, and new vs ongoing treatment; patients in categories 1 to 3 were to receive carboplatin. Two reviewers not involved in the original decisions later recategorized patients using medical records.

Of 483 patients (median age, 66 years; 73% women), 222 (46%) received carboplatin. The independent review agreed with 56% of documented priority categories and 74% of allocation decisions; 126 decisions (26%) did not align with policy intent. A total of 148 patients (31%) had no documented category, and 54 (11%) were missing from the central tracking list. Among 146 category disagreements, 51% could not be explained because of missing documentation, and 21% involved cisplatin contraindications.

In adjusted models of actual allocation, male patients (odds ratio [OR], 2.72; 95% CI, 1.26-5.99) and patients treated at the main campus (OR, 2.13) were more likely to receive carboplatin. These associations were not statistically significant in models based on the independent review, which the authors said suggests bias may have arisen during implementation rather than from the policy itself. The authors noted that the associations do not imply causality, that the review was retrospective and based on medical records, and that the findings come from 1 well-resourced health system.

The authors said explicit documentation, contemporaneous monitoring, and enforcement mechanisms may improve implementation; their institution has since adopted a shortage management policy reflecting these recommendations. They noted that several generic chemotherapy drugs, including carboplatin, were again in shortage as of June 2026.

Source: Blackstone EC, Wang Y, Inyang EA, et al. Allocation policy implementation during a severe chemotherapy shortage. JAMA Netw Open. 2026;9(10):e2633164. doi:10.1001/jamanetworkopen.2026.33164