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. 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.
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?
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).
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.
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.
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/
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.. 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.
Oncologists are worried: Antibiotic resistance threatens modern cancer care
Actions We Must Take | Antimicrobial Resistance Fighter Coalition
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 :
 Porooshat Dagostar (2019) “Antimicrobial resistance: Implications and Costs” Infection and Drug resistance, 12: 3903–3910.
 GARDP session proposal submission for WCC 2020
 ReAct Policy Brief: Successful cancer treatment relies on effective antibiotics
 Longitude Prize report - EFFECTIVENESS OF CANCER TREATMENTS THREATENED BY RISING ANTIBIOTIC RESISTANCE