How to contain the threat of antimicrobial resistance to people living with cancer?

For people living with cancer, antimicrobial resistance (AMR) – the ability of microorganisms such as bacteria, fungi and viruses to resist the medicines designed to kill them – can be life-threatening. Their immune systems are often significantly weakened due to the cancer itself and its treatments, such as undergoing surgery, which further expose them to infection.

In fact, because of AMR, infections are the leading cause of death for cancer patients after the cancer itself. This underscores the importance of developing new strategies and treatments to counteract the rising issue of AMR for this vulnerable group – and preserve the progress that is being made in treating cancer, which AMR is threatening to reverse.

One of the key contributing factors to this emerging crisis, which the World Health Organization (WHO) has listed among the top 10 global public health threats facing humanity,  is the overuse and misuse of antimicrobial medicines.

These medicines are sometimes prescribed in situations where they are not appropriate, thereby leading to resistance, dispensed without professional oversight and used against viral infections such colds and flu that they are not designed to fight. Additionally, the use of antibiotics as growth promoters in animals or as preventive measures in otherwise healthy animals contributes to resistance.

Low and middle-income countries (LMICs) particularly also suffer from the presence of substandard or falsified medicines and a lack of access to timely and appropriate treatments, which exacerbates the development of drug resistance. For people with cancer, these challenges are magnified by inadequate healthcare infrastructure, making cancer treatment difficult to access and expensive.

There are other systemic barriers to addressing AMR, which include poor surveillance mechanisms as well as a lack of data, low access to diagnostics and appropriate antimicrobials, and of economic incentives for pharmaceutical companies to develop new antibiotics and other antimicrobials, since these medicines are designed to be used sparingly.

World AMR Awareness Week (WAAW), which takes place every year from the 18-24 November is a reminder designed to draw the attention of policymakers as well as the general public to this issue, whose root causes are not easy to define.

The theme for this year’s WAAW remains ‘Preventing antimicrobial resistance together’ – and there are pathways forward to ensure that the world does not return to the time before penicillin when there were no medical means to fight infection.

From immediate action to long-term solutions

Short and medium-term actions can already significantly mitigate the crisis, starting with widespread education on the dangers of AMR to limit the misuse of medications, and implementing robust clinical guidelines and patient awareness, along with improving water, sanitation, and hygiene infrastructure.

Healthcare providers should adopt multisectoral policies for the rational use of antimicrobials and diagnostics, adhering to guidelines like the WHO AMR Implementation Handbook and the WHO AWaRe (Access, Watch, Reserve) antibiotic book.

Investment in developing new and effective rapid diagnostics must also be accelerated, and regulatory measures are needed to tackle the over-the-counter sales of antimicrobials and to promote appropriate use among healthcare professionals, while systems should be in place to ensure that medicines meet quality standards, which is vital for responsibly managing healthcare resources and providing effective treatment for all (i.e. AMR Stewardship).

Data collection is another essential aspect. Participation in the Global Antimicrobial Resistance Surveillance System (GLASS), for instance, ensures global data sharing, providing vital insights into resistance patterns. Focused surveillance can lead to improved clinical care and guidelines, specifically tailored to the needs of patients.

Furthermore, lessons can be drawn from other challenges such as pandemic preparedness and climate change to inform AMR policy. A global initiative similar to the US President Biden’s Cancer Moonshot project, could mobilise resources on an unprecedented scale, leveraging information systems that integrate cancer registries with microbiology databases. This, alongside sustainable infrastructure for water, sanitation and hygiene (WASH) to improve infection control and prevention, could significantly improve the management of antimicrobial resistance in cancer patients.

Addressing the need for new antimicrobials will require not only investing in research and development but also innovative models for funding. The UK, for example, has set a precedent by adopting the world’s first subscription payment model for antibiotics. This approach de-links reimbursement from volume, focusing instead on social value.

Public private product development partnerships provide another example, such as the Global Antibiotic Research and development Partnership (GARDP), which co-develops medicines with companies.

Exploring mechanisms such as these while ensuring optimal use of current antimicrobials is the way forward,  

The next high-level meeting on AMR is scheduled for September 2024. This is an opportunity for stakeholders to reaffirm commitments and translate them into concrete actions and funding. A comprehensive, globally coordinated approach is needed to contain the threat that AMR poses, especially to vulnerable communities such as people living with cancer. With appropriate funding and concerted action, there is still time.

UICC and its members continue to play a role in attempting to reduce the threat of AMR, notably through the AMR Taskforce, which last year issued the AMR Control Supplement to inform policymakers and shape national responses to AMR.