Oncologists are raising alarms about critical chemotherapy shortages, citing disruptions that force substitutions, workarounds, and difficult patient discussions. The reported shortages include carboplatin, cisplatin, oxaliplatin, and ifosfamide, with the U.S. FDA estimating ifosfamide injection formulation shortages through at least October 2026. Practices described strategies such as prioritizing curative-intent cases, using lower-end dosing and sequencing patients consecutively to maximize vial usage. The situation spotlights incentives and manufacturing reliability risks in generic oncology supply chains, where substitution options can be limited for highly sensitive regimens.