When you pick up a prescription for cancer treatment, you expect to get exactly what’s written on the bottle. Unfortunately, that’s not always the case.
Researchers recently conducted the first major study of cancer drug quality across multiple African countries, and what they discovered should concern anyone dealing with cancer treatment. Out of 251 cancer medications tested, nearly one in five didn’t contain the correct amount of active ingredients.
Some medications contained as little as 28% of what they claimed to have. Others had up to 120% – both extremes potentially dangerous for patients fighting cancer.
What they found was eye-opening. Visual inspection – the main quality control method used in all four countries – only caught 9% of the problematic medications. Most quality defects simply aren’t visible to the naked eye.
The study looked at seven commonly used cancer drugs across Ethiopia, Kenya, Malawi, and Cameroon. The team collected samples from 12 hospitals and 25 private pharmacies between April 2023 and February 2024.
What makes this particularly troubling is that these quality problems weren’t limited to sketchy back-alley pharmacies. Major cancer hospitals had just as many problematic medications as private pharmacies. Even drugs that were officially registered with health authorities failed quality tests at similar rates to unregistered ones.
Some medications contained as little as 28% of what they claimed to have. Others had up to 120% – both extremes potentially dangerous for patients fighting cancer.
You might wonder how this could happen. The answer lies in a perfect storm of circumstances.
Cancer care has exploded in these regions. Just a decade ago, Ethiopia and Kenya each treated only a few thousand cancer patients annually. Today, each country treats over 75,000 patients yearly. Similar growth happened in Cameroon and Malawi, where about 20,000 patients now receive cancer treatment each year.
This rapid expansion creates immense pressure to find affordable medications. Consider this: in Cameroon, where the average person earns about $1,674 per year, six rounds of chemotherapy cost nearly $2,000. With such financial strain, governments naturally seek the cheapest available products.
This cost pressure can lead manufacturers to cut corners during production. Meanwhile, regulatory agencies in these countries often lack the resources and equipment needed to properly test these powerful, toxic medications.
The researchers used a technique called high-performance liquid chromatography (HPLC) to precisely measure drug contents. Think of it as a sophisticated chemical analyzer that can detect exactly how much of the active ingredient is actually present in each medication.
A medication might look perfectly normal but contain far too little of the ingredient that fights cancer cells. Or it might have too much, creating dangerous side effects.
This isn’t just about getting less bang for your buck. For cancer patients, receiving the wrong dose can mean the difference between successful treatment and treatment failure – sometimes between life and death.
What they found was troubling. About one in six medications (17%) didn’t meet quality standards. Some contained as little as 28% of the medication they claimed to have, while others had up to 120% – both situations potentially dangerous for patients.
It’s like buying a gallon of milk but getting only a quart. Except this isn’t milk – it’s medication that cancer patients depend on for survival.
Previous incidents highlight these dangers. In 2012, 119 people received fake cancer medication at a Mexican state hospital. In the United States, investigators found fake cancer drugs that contained nothing but water. Kenya documented 551 cases of suspected treatment failure with one particular cancer drug.
The World Health Organization (WHO) has issued multiple alerts about fake cancer medications, including pills that contained only paracetamol instead of powerful cancer-fighting compounds.
For patients and healthcare providers, this research delivers a sobering message: the battle against cancer isn’t just about getting the right diagnosis and prescription. It’s also about ensuring the medications themselves are what they claim to be.
So what can be done about this?
The researchers suggest several practical solutions:
1. Better Testing Equipment: Simple chemical screening devices could help identify problematic medications before they reach patients. Technologies like portable spectrometers – think of them as handheld chemical detectors – could spot many substandard products quickly and affordably.
2. Stronger Regulation: Countries need better systems to monitor medication quality and take swift action against substandard products. This includes training regulators and providing them with proper laboratory equipment.
3. Improved Safety Equipment: Testing these toxic cancer drugs requires special protective equipment and ventilation systems. Many laboratories in lower-income countries lack these safety measures, making proper testing impossible.
4. Better Tracking Systems: Recording which specific brands and batches patients receive could help identify problematic products when treatments fail unexpectedly.
The study revealed some manufacturers with particularly high failure rates. Two companies had failure rates above 70%, while others maintained perfect quality records. This suggests that good manufacturing is possible – it’s just not universal.
Interestingly, expired medications didn’t fail quality tests more often than fresh ones. About 24% of all tested medications had expired before analysis – some by nearly a year – but their failure rate wasn’t significantly different from unexpired products.
This research represents the first systematic investigation of cancer drug quality across multiple African countries. The findings likely apply to other lower-income regions worldwide, potentially affecting countless cancer patients who may never know why their treatment isn’t working as expected.
The study focused on seven specific cancer drugs, but the WHO lists 73 different cancer and supportive care medications as essential medicines. With hundreds of manufacturers and global supply chains, the scope of potential quality problems could be enormous.
For patients and healthcare providers, this research delivers a sobering message: the battle against cancer isn’t just about getting the right diagnosis and prescription. It’s also about ensuring the medications themselves are what they claim to be.
As cancer care continues expanding globally, addressing medication quality will be crucial for giving patients their best fighting chance. The first step is acknowledging the problem exists. The next is taking action to fix it.
The researchers hope their work will inspire the same kind of systematic quality investigation that helped address antimalarial drug problems in Asia during the 2000s. Back then, researchers like Paul Newton exposed widespread quality issues with malaria medications, leading to significant improvements in drug quality and patient outcomes.
Perhaps it’s time for similar attention to cancer medications – before more patients suffer from treatment failures they never saw coming.
The full study, published in The Lancet Global Health can be found on this page.