Antimicrobial resistance (AMR), including antibiotic resistance, adversely affects cancer treatment and could undermine key advances being made in cancer care. The growing cancer burden, in combination with the increasing threat of AMR, is a global public health issue that needs to be addressed urgently. It affects everyone, everywhere.
Why is AMR a major issue for cancer treatment and care and what is UICC doing to increase knowledge and raise awareness of the topic within the cancer community?
Antimicrobial resistance (AMR) is a growing public health issue and needs urgent attention in countries around the world. 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 antihelmintics).
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.
Antimicrobial resistance also causes a strain on health systems. 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. 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.
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. Other contributing factors include inadequate infection control, a lack of affordable 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.
Antibiotics help our bodies to kill the types of bacteria that make us sick
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
The resistant bacteria start to multiply, making our antibiotics less and less effective
Image source: PHARMAC, NZ - https://www.pharmac.govt.nz/keepantibioticsworking/
Over the past decades, there has been substantial progress in cancer care, with key advances across the core pillars of surgery, radiotherapy and medicines, including the newer immunotherapies. However, the significant and growing threat of drug-resistant bacteria 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. 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.
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  and address this crisis, which could roll back progress made to date in cancer treatment.
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 :
The threat of antimicrobial resistance and its impact on undermining cancer treatment is a priority for UICC. Currently, knowledge and awareness of the impact of antimicrobial resistance on cancer outcomes within the cancer community is low. It is urgent that oncology professionals, cancer advocates, programme managers, patient groups and other stakeholders working in the field of cancer understand and address the factors that contribute to the development and spread of AMR and strategies for infection control.
In this regard, UICC will develop information to increase awareness and support the cancer community to come together and drive policy change, taking forward the WHO global action plan on antimicrobial resistance adopted by the World Health Assembly in 2015, which outlines the following five objectives:
UICC has already created a task force of experts on AMR and its impact on cancer care outcomes. The task force will showcase current evidence, identify research gaps in knowledge of cancer and AMR, share best practices, and ultimately engage the cancer community to collaborate and bring about policy change on addressing the threat of AMR.
 Porooshat Dagostar (2019) “Antimicrobial resistance: Implications and Costs” Infection and Drug resistance, 12: 3903–3910.
 GARDP session proposal submission for WCC 2020