For World Antimicrobial Awareness Week (WAAW), Dr Cary Adams shares with us the importance of raising awareness on the growing threat of antimicrobial resistance and how it affects the cancer community.

In what circumstances and how often are antibiotics used for cancer treatment and care?

The treatment and care of cancer involves a wide range of interventions namely surgery, radiotherapy, chemotherapy, novel targeted therapies, and medicines for palliative care. Antimicrobials, which include antibiotics, play a role in the treatment protocols for almost all of these interventions. For example, they are given to patients following chemotherapy as a measure to protect them from infections due to a weakened immune system. Furthermore, antibiotics are an essential part of treatment for certain cancers like multiple myeloma and acute leukaemia. Treatment for many cancers, like those of the breast, thyroid, testis, and urinary bladder involves a surgical intervention that require antibiotics to prevent surgical site infections.

Is antimicrobial resistance an issue for cancer treatment and care? What impact can it have on patients?

AMR, including antibiotic resistance, adversely affects cancer treatment and could undermine key advances being made in cancer care. 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 hospitalized due to infection and antibiotics are the main line of defense for these patients. Due to AMR, these infections are becoming harder to treat which results in poor treatment outcomes for these patients. A recent survey of 100 oncologists in the UK revealed that 95% of the oncologists surveyed are already very concerned about the threat of drug resistant bacteria on the future of cancer treatment and care.

Furthermore, country examples also reveal disturbing data. For example, in India almost 73% of patients with haematological malignancies carried bacteria resistant to carbapenems, which is a last line antibiotic.

In what way is this year’s WAAW theme “United to preserve antimicrobials” relevant to cancer care and treatment?

Cancer is the second leading cause of death globally and about 1 in 6 deaths is due to cancer. This growing cancer burden, in combination with the increasing threat of AMR, is a global public health issue that needs to be addressed urgently.

Currently, knowledge and awareness of the impact of AMR on cancer outcomes within the cancer community is low.  It is therefore 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.

This year’s WAAW is an opportunity to raise awareness on the impact of AMR on cancer care and a call to action for all relevant stakeholders.

What is the cancer community doing to slow down antimicrobial resistance? and what can the healthcare industry do to help?

Addressing AMR is a priority for UICC. To this effect, we have convened a Task Force on AMR and Cancer Care whose aim is to highlight the current evidence on AMR, identify areas where research and knowledge about AMR and cancer care can be strengthened, share best practices, facilitate collaboration within the cancer community, and help bring about policy change on AMR.

In this regard and as a first crucial step, UICC is releasing information in the form of news articles and blogs, as well as virtual dialogues on the impact of AMR on cancer care. These resources have been developed for our members, the cancer community and the AMR community and will be our focus for World Antimicrobial awareness week (WAAW) 2020.

One of the key areas that UICC is committed to is the availability, affordability and sustained access to quality assured medicines and diagnostics, for existing essential medicines and diagnostics, but to also include R&D for new medicines and diagnostics. The healthcare industry should collaborate with governments and civil society to ensure this happens. Furthermore, stronger investment and a collaborative approach is needed for the research and development of new antibiotics, vaccines, diagnostics, and other tools to combat AMR.

Do you understand why there is so much innovation for cancer care, but such little progress in finding new antibiotics?

Yes, there has been huge advances with treatments for cancer care, especially with the novel targeted therapies. Unfortunately, the same cannot be said for antibiotics. This is because incentives for industry to invest in antibiotics are declining.  In fact, many large pharmaceutical companies have dropped antibiotics from their portfolios due to the unfavourable return on investment.

Furthermore, any new products that come to the market will most likely be heavily controlled due to efforts aimed at reducing AMR.

There is therefore, an urgent need for governments and other key players to come together and explore innovative ways to fund R&D, increase collaborative networks and ensure there is sustainable supply of antibiotics, especially in LMICs.

Author

• Cary Adams