By Shalini Jayasekar Zürn, Senior Advocacy Manager, Union for International Cancer Control
There has been significant progress in cancer care in recent decades, with key advances across the treatment modalities of surgery, radiotherapy and medicines, including new targeted therapies. The significant and growing threat, however, of drug-resistant bacteria – or antimicrobial resistance (AMR) – is undermining all the above-mentioned progress in cancer care.
People with cancer are more susceptible to infections due to the lowering of immune defenses, while surgery and treatments like bone marrow transplants, radiotherapy and chemotherapy put enormous strain on the immune system. Catheters and other devices used in treatment also often causes the development of infection. As many as 1 in 5 cancer patients undergoing treatment are hospitalized due to infection, and antibiotics are the main line of defense.1. Pneumonia and sepsis 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.2
Furthermore, while there is a lack of comparable data on a global scale, several in-country studies provide a picture of the reality of the risk of antibiotic resistant infections in cancer patients. In India, for instance, about 73% of patients with blood cancers harbored bacteria present in their gut that were resistant to carbapenems, a last-line antibiotic3. While this assessed gut colonization of resistant bacteria, the gut is a common source of drug resistant bacteria that can later cause true infection. Another country example is Uganda, where 85% of certain class of bacteria (Enterobacteriaceae) which cause bloodstream infections in cancer patients were multi-drug resistant.4
“AMR affects everyone and all stakeholders have a role to play in addressing this silent pandemic. In particular, we must emphasise the need to conserve treatments and increase access to rapid diagnostic tests.”
- Ulrika Årehed Kågström, Secretary General, Swedish Cancer Society, UICC Board Member and member of the UICC-led AMR and cancer care task force
Addressing AMR is a priority for Union of International Cancer Control (UICC). Currently, knowledge and awareness of the impact of AMR on cancer care outcomes is low, within the cancer community. The oncology health workforce, cancer advocates, programme managers, patient groups and other stakeholders working in the field of cancer must understand the urgency of this silent pandemic and address the factors that contribute to the development and spread of AMR and strategies for infection control. The cancer community and relevant stakeholders need to join forces with other global health actors, including stakeholders in communicable diseases, and bring together best practices and resources to overcome the challenge that AMR poses to cancer patients and caregivers around the world.
In this regard, as a vital first step in addressing this huge global public health problem, UICC is raising awareness and knowledge of the threat of AMR on cancer care outcomes and supporting the cancer community in coming together and pushing for policy change.
In April, there was a call to action at the High-Level Interactive Dialogue on AMR, hosted by the President of the United Nations General Assembly, calling for multisectoral engagement with all relevant stakeholders. UICC’s partnership with BD (Becton, Dickinson and Co.)is one such example of a collaboration where combined resources and strengths can increase awareness and mobilize action on addressing AMR within the cancer community. Furthermore, this partnership builds on the BD’s longstanding work on highlighting the importance of infection control, surveillance and data, and accessing appropriate treatments, especially diagnostics.
UICC and BD aim to develop news articles and special focus Virtual Dialogues on improving surveillance to strengthen the learning around the impact of AMR on cancer care. Furthermore, this collaboration will also aim to improve practice and drive policy change through the development of educational and learning materials, for example the UICC Master course on AMR.
There are many steps that individuals, policymakers, healthcare workers and the industry can take to reduce the threat posed by AMR as a serious global public health issue. Everyone has a role to play to ensure that people living with cancer can continue to hope for the best possible chance of survival.
1. GARDP session proposal submission for WCC 2020
2. Crit Care 2004 Oct;8(5):R291-8. doi: 10.1186/cc2893. Epub 2004 Jul 5.Hospitalized cancer patients with severe sepsis: analysis of incidence, mortality, and associated costs of care (please use this article as the reference, this is the source document)
3. Kumar A, Mohapatra S, Bakhshi S, Mahapatra M, Sreenivas V, Das BK, et al. Rectal Carriage of Carbapenem- Resistant Enterobacteriaceae: A Menace to Highly Vulnerable Patients. J Glob Infect Dis. 2018 Dec;10(4):218–21.
4. Lubwama M, Phipps W, Najjuka CF, Kajumbula H, Ddungu H, Kambugu JB, et al. Bacteremia in febrile cancer patients in Uganda. BMC Res Notes. 2019 Jul 30;12(1):464..
Shalini is a senior advocacy manager and focal point for the work on access to treatment in UICC. She is a biologist by training and has extensive experience on the issues of access to quality assured medicines. She gained experience on this topic by working with the World Health Organization in Geneva, Switzerland, MSF’s Access Campaign in India, and other NGOs at the international and national level. She also has experience working with the pharmaceutical industry where her focus was on medicines safety.