US Cancer Drug Shortages Persist at Every Major Cancer Center, NCCN Finds

Every one of the 34 academic cancer centers in the National Comprehensive Cancer Network (NCCN) reports a current shortage of at least one anticancer medicine, and more than one in five is short of five or more different agents. The numbers come from the NCCN 2026 Drug Shortage Survey, published on 10 September 2026, and they confirm that US cancer drug shortages have not eased since NCCN began polling its members in 2023.

The survey combined two instruments run from 4 to 27 August 2026. Operations questions went to the Best Practices Committee, which represents 31 centers, and questions requiring professional judgment went to the Pharmacy Directors Forum, with 23 centers. Independent reporting of the same dataset put two-or-more-agent shortages at 87.1% and five-or-more at 22.5%. The survey is a census of NCCN’s academic members, not a probability sample of US oncology; community practices appear only as reported by academic centers, and item denominators vary because not every respondent answered every question.

US cancer drug shortages: the medicines affected

The list is dominated by older, low-margin sterile injectable generics that remain backbone therapy across common solid tumors, sarcomas, and hematologic cancers.

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Other agents named on the chart include dacarbazine, oxaliplatin, docetaxel, streptozocin, 5-fluorouracil, dexrazoxane, etoposide, leucovorin, and lorazepam. Write-in responses added triamcinolone acetonide, hydromorphone, romidepsin, pentostatin, epirubicin, tocilizumab biosimilars, cyclophosphamide, iohexol, and chlorambucil. No center selected amifostine, hydrocortisone, methotrexate, topotecan, vinblastine, vincristine, or “none.”

The pattern is structural. Sterile injectable generics carry thin manufacturer economics and concentrated production, and demand does not disappear when a plant goes offline. Ifosfamide was added to the FDA shortage list in June 2026. Carboplatin’s return to 71% shows that the 2023-24 recovery did not hold.

What the shortages mean for treatment

Most centers can still treat current patients on the intended dose and schedule, but often only by changing how they use inventory. Sixty-one percent require mitigation strategies, 32% do not, and 7% cannot treat all patients as intended. That 7% is small in absolute terms but matters clinically: some patients at leading academic centers are already off protocol because the product is not there.

Waste-management strategies are the first-line conservation tool, used by 79% of centers. Forty-three percent limit use of current stock. Thirty-two percent use the range minimum for a recommended dose, 21% use the range maximum for a treatment interval, and 29% reported other, unlisted tactics. NCCN’s statement adds that some centers moved patients onto alternative recommended regimens to stay inside guidelines.

Prior authorization adds to the load

When a shortage forces a plan change, 90% of centers must re-clear payer authorization. Sixty-six percent need repeat prior authorization both before initiation and during treatment, 14% only before initiation, and 10% only during treatment. Just 10% need none.

Sixty-nine percent reported no delay, 17% a treatment delay attributable to re-authorization, and 14% said the question did not apply.

Committees, community spillover, and trials

Seventy-one percent of centers run a multidisciplinary drug-shortage committee; 29% do not. Pharmacy and physicians sit on every committee, nursing on 86%, bioethics on 50%, administrative staff on 41%, risk management or legal on 27%, and other roles on 36%. Patient notification of interim protocols is the weakest duty on the list, reported by only 32% of committees, well behind notifying clinical staff and tracking inventory.

Academic-center shortages are not contained on campus. Seventy-seven percent of centers are aware of shortage problems in nearby community practices; 23% are not. Thirty-nine percent say shortages have affected clinical trials at their center.

Policy has not moved the needle

Pharmacy directors gave the 2023-26 policy record a near-unanimous “no change” grade. Ninety-six percent said national and state policy had left shortages “about the same” since 2023, 4% said better, and none said worse. Directors are not describing a worsening crash; they are describing US cancer drug shortages that policy has failed to move.

Their preferred remedy is economic, not regulatory. Ninety-one percent want incentives for high-quality generic manufacturing, including tax incentives for manufacturers. Fifty-seven percent want information systems to rate generic suppliers so hospitals can contract on quality. Forty-eight percent want generics exempted from tariffs, while only 9% favor adding tariffs on offshore product. A CMS-style buffer-stock payment drew 35%, hospital incentives for high-quality suppliers 30%, and restrictions on group purchasing organizations pushing generic prices below a floor 30%. A 340B discount exemption drew 9%, 13% gave other answers, and 4% were unsure.

Alyssa Schatz, DrPH, MSW, NCCN Vice President of Policy and Advocacy, quoted a respondent: “many oncology generics are clinically indispensable but economically unattractive. Without correcting that economic imbalance, shortages are likely to recur.” Directors also asked for earlier manufacturer notification to the FDA.

Leadership on the record

Crystal S. Denlinger, MD, Chief Executive Officer of NCCN, said: “It is disheartening that we remain in the same situation, including recurring or continued shortages of some drugs, despite years of raising the alarm and providing insight about this disruptive and dangerous issue for cancer care in America. The good news is the cancer centers in our network have developed internal strategies, task forces, and communications plans for keeping patient care and clinical trials on track. The bad news is that this takes time and attention that could be better spent on improving patient experiences and outcomes and adds additional stress to an already burdened system.”

NCCN is a member of the End Cancer Drug Shortages Coalition, which issued a consensus statement in May 2026. Earlier NCCN survey waves from June 2023, September 2023, and June 2024 remain posted at NCCN.org/drug-shortages.

Source: NCCN 2026 Drug Shortage Survey Results and NCCN Findings on Cancer Drug Shortages, 10 September 2026.