Antimicrobial resistance and its impact on cancer care

Antimicrobial resistance (AMR) or drug resistance, including antibiotic resistance, is a growing public health issue and needs urgent attention in countries around the world. An estimated 750,000 people die annually from drug-resistant infections and by 2050 this number could reach ten million and cost more than USD 100 trillion without collective action.

Antimicrobial resistance also causes a strain on health systems[1]. Many studies have demonstrated the financial consequences of AMR, including extremely high healthcare costs due to an increase in hospital admissions, longer hospital stays, more intensive care units and isolation beds, and expensive, intensive therapy.[2] Healthcare professionals are also forced to use less conventional antibiotics or a combination of different antibiotics to treat these infections, which are usually more expensive and which could also have serious side effects.

AMR also undermines key advances being made in cancer care by adversely affecting cancer treatment and threatening the survival of people living with cancer. 

Why is AMR a major issue for cancer treatment and care and what is UICC doing to increase knowledge, raise awareness and address this “silent pandemic” within the cancer community in order to improve cancer care outcomes?

What is antimicrobial resistance?

AMR happens when microorganisms (such as bacteria, fungi, viruses, and parasites) change and are still able to grow, even when they are exposed to antimicrobial medicines that are meant to kill or limit their growth (such as antibiotics, antifungals, antivirals, antimalarials, and anthelmintics).

How is AMR linked to cancer?

 

People with cancer are more susceptible to infections due to the lowering of immune defences. As many as 1 in 5 cancer patients undergoing treatment are hospitalised due to infection, and antibiotics are the main line of defence.

 

As a result, the medicines become ineffective and infections persist in the body, increasing the risk of spread to others. While antimicrobial resistance refers to all microbes that resist treatments designed to destroy them, antibiotic resistance specifically deals with bacteria that are resistant to antibiotics.

Usually, the more often antibiotics are used, the more bacteria adapt and find new ways to survive, which means they become resistant to antibiotics. Instead of being killed by the antibiotics, some bacteria survive and continue to multiply, causing more harm. Antibiotics are used in the treatment of many diseases and surgical procedure. Examples include organ transplants, blood infections, complicated deliveries, pneumonia and in cancer care (see ReAct Group).  Therefore, patients with infections caused by these drug-resistant bacteria are at an increased risk of poorer clinical outcomes, including death.

Did you know? Currently, at least 700,000 people die every year due to drug-resistant infections. (see this UN News)

Overuse and misuse of anti-microbial medicines are major factors that have contributed to the development of drug-resistant microbes. In many places, antibiotics are overused and misused in people and animals, and often given without professional oversight. Examples of misuse include when they are taken by people with viral infections like colds and flu, and when they are given as growth promoters in animals or used to prevent diseases in healthy animals[3].

Another major reason for the development of drug resistance is the lack of access to timely and appropriate treatments for infections, especially in LMIC.

Did you know? Out of 25 new antibiotics developed between 1999 and 2014,
only 12 were registered in more than 10 countries.

Did you know? According to a recent survey by the European Association of Hospital Pharmacists, 63% of hospital pharmacists listed antimicrobial medicines most frequently in shortages, while medicines for cancer were second on the list. (read more)

Other important contributing factors include inadequate infection control, a lack of access to affordable and appropriate diagnostics that give accurate and real-time results and substandard/falsified medicines.

In June 2020, WHO expressed their concern that the increasing trend of antimicrobial resistance will further be fuelled by the inappropriate use of antibiotics during the COVID-19 pandemic.

How antibiotic resistance develops

Antibiotics get less effective

Antibiotics help our bodies to kill the types of bacteria that make us sick.

Antibiotic resistance

Some of the bacteria that make us sick get better at defending themselves against antibiotics, meaning resistant bacteria are harder to kill. This is called antibiotic resistance.​

Antibiotics help our bodies to kill bacteria that makes us sick

The resistant bacteria start to multiply, making our antibiotics less and less effective.

Image source: PHARMAC, NZ - https://www.pharmac.govt.nz/keepantibioticsworking/

 

Causes of antimicrobial resistance

 

How does antibiotic resistance impact cancer care outcomes?

There has been substantial progress in cancer care in the past decades, with key advances in surgery, radiotherapy and medicines, including the newer immunotherapies. The significant and growing threat of drug-resistant bacteria, however, is undermining all the above-mentioned efforts in cancer treatment. In fact, cancer care is highly affected by AMR. People with cancer are more susceptible to infections due to the lowering of immune defences, while surgery and treatments like bone marrow transplants, radiotherapy and chemotherapy put the immune system under immense pressure. As many as 1 in 5 cancer patients undergoing treatment are hospitalised due to infection, and antibiotics are the main line of defence.[5]. Pneumonia and sepsis (as a result of bacterial infection of the blood) are among the most frequent causes of admission to intensive care units for cancer patients. In fact, it is estimated that 8.5% of cancer deaths are due to severe sepsis.[6]

Antibiotics are a key and indispensable part of cancer treatment – many patients simply have to take them – and we owe it to them to better manage our use of the drugs [7] and address this crisis, which could roll back progress made to date in cancer treatment.

Oncologists are worried: Antibiotic resistance threatens modern cancer care

Actions We Must Take | Antimicrobial Resistance Fighter Coalition

 

Ways to slow down antimicrobial resistance

AMR is a serious global public health issue that needs to be addressed immediately and everyone has a role to play.

For steps that individuals, policymakers, healthcare works and the industry can take, please see below some actions that WHO recommends :

Individual_icon

Individuals

  • Only use antibiotics when prescribed by a certified health professional.
  • Never share or use leftover antibiotics.
  • Prevent infections by regularly washing hands, preparing food hygienically, avoiding close contact with sick people, practising safer sex, and keeping vaccinations up to date.
Policy_icon

Policy makers

  • Ensure a robust national action plan.
  • Improve surveillance of antibiotic-resistant infections.
  • Regulate and promote the appropriate use and disposal of quality medicines.
  • Make information available on the impact of antibiotic resistance.
Hospital_icon

Healthcare industry

  • Invest in research and development of new antibiotics, vaccines, diagnostics and other tools.
Doctor_icon

Health professionals

  • Prevent infections by ensuring your hands, instruments, and environment are clean.
  • Only prescribe and dispense antibiotics when they are needed.
  • Report antibiotic-resistant infections
  • Talk to your patients about how to take antibiotics correctly, antibiotic resistance and the dangers of misuse.
  • Talk to your patients about preventing infections.
agriculture_icon

Agriculture sector

  • Only give antibiotics to animals under veterinary supervision.
  • Not use antibiotics for growth promotion or to prevent diseases in healthy animals.
  • Vaccinate animals to reduce the need for antibiotics.
  • Support the implementation of effective interventions put in place to reduce the spread of AMR through the environment.

Source: WHO Factsheet on antibiotic resistance 

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Last update: 
Thursday 23 September 2021
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Bacteria Staphylococcus aureus on the surface of skin or mucous membrane. Staphylococcus aureus can be highly resistance to antibiotics.
30 July 2021
Blog

Improving tools for combatting antimicrobial resistance

Diane Flayart at UICC's partner BD looks at common needs and interventions for COVID-19 and AMR and how to apply learnings from the COVID-19 pandemic to the global challenge of drug-resistant infections.

Virtual meeting of the 74th World Health Assembly
10 June 2021
News

The 74th World Health Assembly focuses on resilience and equity

At WHA74, participants examined the global response to COVID-19, future pandemic preparedness, equitable access to medicines, social determinants of health and antimicrobial resistance.

Person holding a blister pack of medicine
17 May 2021
News

Cancer treatment threatened by increasingly ineffective antimicrobial drugs

As pathogens become ever more resistant to antimicrobial drugs such as antibiotics, people living with cancer run a growing risk of adverse treatment outcomes, including death from an infection, even though their cancer is treatable.

Antibiotic resistance is among the many challenges facing the ability of countries in Sub-Saharan Africa to properly manage cancer patients
24 November 2020
Blog

The impact of AMR on cancer care in Sub-Saharan Africa

To mark World Antimicrobial Awareness Week, Mirfin Mpundu and Zipporah Ali share their views on the impact of AMR on cancer care outcomes in Sub-Saharan Africa and why urgent action is required to address this threat. 

The significant and growing threat of antibiotic resistance is severely undermining the ability of health practitioners to treat cancer.
16 November 2020
Blog

Drug resistance threatens the future of cancer care: what can be done?

Marking World Antimicrobial Awareness Week, Manica Balasegaram explains why urgent action is required to address the threat that drug resistance poses to cancer care.

Antimicrobial resistance threatens cancer care
7 July 2020
News

The impending public health crisis of antimicrobial resistance

The growing resistance of microbes to medicines that are designed to fight off infections threatens to strain health systems worldwide and could seriously compromise better cancer treatment outcomes.