In 2018, WHO reported 18.1 million new cancer cases and 9.6 million deaths due to cancer globally, with the highest-burden in LMICs. Sub-Saharan African countries face a triple burden of infectious diseases, a legacy of HIV/AIDS and rising incidences of different types of cancer: breast, cervical, prostate and pancreatic. Breast cancer is the second most common cancer globally and the leading cause of death among women in sub-Saharan Africa.
Weak health system infrastructure, lack of access to proper diagnostics and affordable treatments, lack of human resources and technical expertise and antibiotic resistance are some of the main challenges we have observed that result in the inability to properly manage cancer patients.
Indeed, while the world finds itself in the grips of the coronavirus pandemic, the rising threat of antimicrobial resistance (AMR) is another, silent pandemic that has been building for some time and which poses significant challenges to treating cancer effectively.
Bacterial infections are one of the most common complications for cancer patients. Antibiotics are crucial for patients undergoing radiation therapy, chemotherapy, and surgery. They are essential in the treatment of cancer due to their anti-proliferative, pro-apoptotic and anti-epithelial-mesenchymal-transition (EMT) capabilities (or ability to stop cancerous cells). Antibiotics, such as ciprofloxacin, mitomycin, salinomycin, and doxorubicin, are effective against certain cancers. They are used to treat secondary infections that may arise from ulcers, tissue damage and compromised wound healing that enable disease-causing bacteria to cause infections.
Antibiotics are also used to prevent infections in cancer patients. This is because cells that are part of the defence mechanism against infections are also affected during radiation therapy and chemotherapy lowering the immunity and predisposing them to infections. These treatments are meant to kill harmful cancer cells, but they end up damaging other cells necessary for defence against bacterial infections. This means that cancer patients are left with weakened immune systems, leaving them vulnerable to infections, including infections caused by resistant pathogens. This is particularly crucial in patients with blood cancer and patients with severe neutropenia.
Antibiotic resistance has devastating consequences for cancer therapy and threatens advances made in modern cancer care. Even diagnosing cancer can be dangerous for the patient because of resistant pathogens. For example, taking a biopsy to diagnose prostate cancer can be life-threatening since approximately 1 in every 10 patients (10%) will experience severe infection. Without efficient preventive antibiotic treatment, the risk of infection after a prostatic biopsy is about 50%.
Furthermore, there is a lack of data on AMR and limited published data on the impact of drug-resistant infections on cancer care in Sub-Saharan Africa. Also, to our knowledge, cancer clinicians do not record cases of drug resistance and this leads to further scarcity of data on the issue.
Cancer medicines and second-line antibiotics used to treat resistant pathogens are also very expensive and frequently not available in most sub-Saharan African countries. The lack of drug coverage in universal health programmes, as well as poor coverage of existing universal health coverage (UHC) programmes, compounds the problem, as most patients do not have any insurance coverage for their treatment. Having worked in international health for almost 30 years, it is always heart-breaking assisting cancer patients whose hopes hinge on the possibility of being treated with donated medicines or thanks to their families scraping money together for treatment abroad, yet who ultimately have to give up due to not being able to afford care. These are our lowest moments, and these situations illustrate the disparities in accessing quality care that unfortunately still exist around the world.
Globally, countries have committed to the Sustainable Development Goals (SDGs) – a set of goals and targets to improve upon existing disparities. Yet the challenges with respect to fighting cancer and the rise of resistant pathogens threaten our global achievements towards reaching these goals. Governments and all stakeholders must mobilise and engage in collective action to prevent and fight cancer, in order to reach the SDG of reducing premature mortality from non-communicable diseases (NCDs), including cancer, by one-third by 2030.
In May 2015, the World Health Assembly (WHA) endorsed a Global Action Plan on AMR and urged all Member States to develop National Action Plans for AMR. In June 2020, WHO expressed its concern that the increasing trend of AMR will further be worsened by the inappropriate use of antibiotics. Knowledge and awareness of the link between AMR and cancer, and the impact of AMR on cancer patient outcomes, are unfortunately low, highlighting a need to raise awareness of the relationship between these two global health threats amongst key stakeholders.
We must also address the issue of lack of data, as this is the first step towards policy change. Cancer advocates and advocates in the AMR space need to come together to collaborate on data and surveillance, access to medicines and diagnostics, and mobilise action at the national and global level. Such concerted global action to fight AMR is urgently needed to address the disparities in cancer management and treatment, and strengthen health systems to meet the challenges that patients face in obtaining effective cancer therapy, including antibiotics.