Breast cancer survivor says Tamoxifen drug shortage is at 'crisis point'

A breast cancer survivor is sounding the alarm bell about her experience scouring pharmacies in the Halifax area for Tamoxifen, but an official with the Nova Scotia Health Authority assures patients there is a "reasonable" supply of the drug across the province.

Tamoxifen is an oral drug used to treat breast cancer and to prevent it from returning.

The health authority's cancer care program contacted pharmacies and primary-care providers in mid-October to make them aware of a Canada-wide shortage of the drug, which is being caused by manufacturing disruptions.

Shortages were first reported in August, according to drugshortagescanada.ca, which is the website where drug shortages and discontinuations in Canada are reported.

The health authority issued a press release on Thursday assuring patients "there is still drug available in Nova Scotia."

But patient Wendy Ackerley said she had a frustrating experience trying to fill her Tamoxifen prescription in Halifax last Thursday.

"I was in a bit of a state of shock and a bit of a state of panic…. What if I can't find this?" said Ackerley, who was prescribed Tamoxifen after being diagnosed with breast cancer and undergoing a mastectomy in the fall of 2017.

Ackerley, 47, said she was told by the pharmacist at her regular Guardian pharmacy that it had no supply of Tamoxifen, and that other Guardian locations in Halifax were also out. The pharmacist even called some competitors, but they also did not have the drug.

Ackerley was then told she should start calling around to pharmacies herself. She said she was told by another pharmacist during one of those calls that she wouldn't find Tamoxifen in Halifax, and that she should start looking outside the city.

Eventually she was able to obtain a one-month supply of the drug, one-third of her regular prescription, at a pharmacy in Hubbards, N.S.

She said she spoke with an acquaintance who had to drive to the Annapolis Valley to have her Tamoxifen prescription filled.

"Needs are not being met," she said. "I feel lucky that I'm able to get in my car and drive to a rural location to fill my prescription, but there are many women who can't."

Ackerley was told by the pharmacist that the Nova Scotia Health Authority had instructed them to only give patients a one-month supply to help manage the overall supply of Tamoxifen in the province.

'This is at a crisis point'

The authority mentioned the new measure in its press release Thursday, but Ackerley wondered why patients were not told sooner. She said she's been frustrated by what she described as a lack of communication.

"This is at a crisis point," said Ackerley. "I'm really frustrated with how this has been handled…. I'm frustrated with the lack of information about why this has happened and how it's going to be resolved."

Dr. Drew Bethune, senior medical director of health authority's cancer care program, said a team has been set up to monitor the "fluid" situation.

"It's a moving target exactly knowing how much drug we have," said Bethune. "We have a reasonable supply of Tamoxifen, but we will need more."

Bethune said it was his understanding that there are some pharmacies in Halifax that have the drug.

"There are 300 pharmacies in Nova Scotia and we don't know the supply in each and every one of them," he said.

"We've been asking pharmacies to call around if they do not have supply when a patient requests it. We've been asking the amount dispensed to be limited to [a] one-month supply, which will enable us to share what we have."

Bethune said "there's a good likelihood" that there will be more supply coming in the near future.

Toll-free Tamoxifen line

In response to Ackerley's concerns about a lack of communication with patients, Bethune noted the authority has set up a toll-free Tamoxifen information line (1-844-989-1502) for patients and health-care providers.

The health authority later clarified that the information line was established two weeks prior to the publication of its advisory Thursday.

Bethune said that if the drug shortage is not resolved over the next several weeks, "there aren't easy options."

"Patients will have to be assessed individually in many cases," he said, noting that work is underway to come up with such a plan if the situation warrants.

"There are different clinical situations in which Tamoxifen is used and it would have to be looked at in the individual patient situation… but we are very hopeful that this will not be necessary."

According to a statement from Health Canada, three companies who make the drug are reporting shortages in Canada. One of them, Apotex Inc., says it anticipates the shortage will end Dec. 31, as opposed to the previously reported date of Jan. 31, 2020.