Patients arriving at B.P. Koirala Memorial Cancer Hospital in Bharatpur are facing growing uncertainty as supplies of two essential chemotherapy drugs, carboplatin and cisplatin, run short, forcing many cancer patients and their families to spend days searching for medicines needed to continue treatment.

Doctors say the shortage, which has persisted for weeks, stems from a global scarcity of active pharmaceutical ingredients (APIs) used to manufacture the medicines, rising raw material costs and higher production and transportation expenses linked to higher fuel prices.

Importers, however, have been reluctant or unable to bring in sufficient quantities, arguing that medicine prices in Nepal have not been adjusted to reflect the higher costs.

The Department of Drug Administration has designated 11 health institutions and medical suppliers nationwide to distribute the scarce medicines. But supplies remain far below demand. In Chitwan district, Raj Drug Pvt Ltd has been assigned distribution responsibility, yet company officials say the available stock is insufficient.

Rajiv Thapa, the company’s proprietor, said carboplatin is available only in limited quantities.

“We received 20 vials of 450 mg and 20 vials of 150 mg carboplatin on Wednesday. All the 450 mg vials were sold out immediately. Demand is at least 40 vials a day,” he said.

For many patients, the shortage has become another burden in an already difficult fight against cancer.

Ekala Mahato of Madi Municipality-3 in Chitwan arrived in Bharatpur to accompany his daughter-in-law Manisha, 24, who has been undergoing chemotherapy for the past six months. When the family could not find the medicine required for her 11th treatment cycle, they were forced to search multiple locations.

“I arrived on Monday, but the medicine wasn’t available. After searching in many places, we finally managed to get it and continue treatment. Now I’m worried whether it will be available next time,” Mahato said.

Poonam Mandal of Ramgopalpur in Mahottari district said she was forced to remain in Bharatpur for four days while trying to obtain medicines for her mother, Rinku Kumari.

“We couldn’t find one of the required drugs even during the second treatment cycle. This time too, we found it only after searching extensively,” she said.

Om Prakash Kumar of Chhipaharmai Rural Municipality-2 in Parsa district said he spent three days searching for medicines needed for his fourth chemotherapy session.

“We are already fighting the disease. Having to struggle for medicines makes it even harder,” he said.

Ganesh Mukhiya, 37, of Shreenagar in Sandhikharka Municipality-1, Arghakhanchi district, said he has faced shortages during several recent treatment cycles.

“You wait in line, but the medicine isn’t available. Then you have to go searching elsewhere,” he said.

The hospital receives patients from across Nepal as well as neighbouring areas of India. Doctors say the shortage of carboplatin and cisplatin over the past month has begun to disrupt treatment schedules and clinical management.

According to Dr Gurusharan Shah, head of the hospital’s Medical Oncology Department, seven to eight out of every 10 chemotherapy patients require one of the two drugs.

The hospital administers chemotherapy to around 400 patients each week, but current supplies are sufficient for only about half of them.

“The government has made some temporary arrangements, but only about half of the required medicines are available in the market. There is effectively a crisis involving carboplatin and cisplatin,” Shah said.

He said reports have emerged of patients purchasing medicines that may have entered the country through unauthorised channels.

“Chemotherapy drugs must be stored at temperatures below 25 degrees Celsius. Medicines carried around in bags may not have been stored properly, which could affect their quality,” he said.

According to Shah, the global shortage and rising cost of APIs used in the production of carboplatin and cisplatin have disrupted manufacturing worldwide. Higher fuel prices have further increased production and transportation costs.

“Warning signs of a shortage had already existed. These are medicines with no effective alternatives. If substitutes are used, treatment outcomes could be compromised,” he said.

Doctors argue that discussions with importers and adjustments to medicine pricing could help improve supply.

“No one can continue importing medicines at a loss. For a long-term solution, the government needs to review both pricing structures and supply mechanisms,” Shah said.

As the shortage persists, patients are increasingly being forced to buy medicines of uncertain quality, purchase drugs from private sources that should be available through health insurance coverage, and endure delays in treatment, raising concerns over both affordability and patient safety.