The AMR Narrative

Why is Antimicrobial Resistance (AMR) a threat for people living with cancer?

Over the past few decades, astounding advances have been made in cancer care. Alongside anti-cancer medicines, radiotherapy, and surgical procedures, antimicrobial medicines are essential therapies. Patients living with cancer rely on effective antibiotics and sometimes antivirals to prevent and treat infections. Their survival depends on these vital medicines working.

Infections are among the most frequent complications in this vulnerable population. One in five cancer patients are hospitalised due to an infection during their treatment, and they have a three times higher risk of dying from an infection compared to patients without cancer due to their compromised immune system.

Different bacteria, fungi, viruses or parasites can cause an infection, but bacteria are most common in cancer patients.

In addition, some of these bacteria are evolving resistance to antibiotics and spreading. This is known as antibiotic resistance.

Antibiotic resistance jeopardises much of the hard-won progress against cancer because, without effective antibiotics the chance of patients surviving the infection is reduced.

To explain this in more depth, the immune system’s ability to deal with infecting bacteria is compromised by the cancer itself, radiotherapy, and chemotherapy. Treatments used to destroy cancer cells become harmful to other cells in the human body, including immune cells. For example, a common side effect of therapy is a reduction in the white blood cell count (neutropenia). White cells are critical to dealing with infecting bacteria, so this seriously compromises cancer patients.

Cancer patients are at a higher risk of bacterial infection because many of the treatments and procedures in hospital include giving bacteria a port of entry into the body e.g., surgery. Over one-third of cancer patients will need surgery as part of treatment. In addition, this may include putting in a urinary catheter or plastic tubes into blood vessels to give fluids, chemotherapy or medicines. These factors dramatically increase the risk of cancer patients getting ‘hospital-acquired infections’.

As more antibiotic resistant bacteria are found in hospitals, the likelihood of a hospital-acquired bacterial infection being resistant to antibiotics is increased.

Pneumonia, urinary tract infections, and bloodstream infections are among the most frequent in cancer patients, extending length of hospital stay, illness, and reducing survival.

At this stage, you might be wondering if there’s anything we can do to address antibiotic resistance and assist in safeguarding patients with cancer?

One way we can reduce the chance of a person getting a bacterial infection of any kind in hospital is to strengthen the basic procedures in place to prevent infection. This includes ensuring health workers and visitors wash their hands. You’d think that was easy, but all too often, it is practiced poorly. All patients and carers, including in the cancer community, have an important role to play in reminding health workers to wash their hands. It doesn’t matter if that is a cleaner, nurse or doctor. Everyone needs reminding!

Measuring the amount of antibiotic resistance (surveillance) in cancer patients is equally important to monitor how resistant bacteria are to antibiotics and help predict and prevent outbreaks of antibiotic resistant bacteria before it is too late to intervene.

Lastly, raising awareness in the cancer community about the impact of antibiotic resistance on cancer care, educating people, and supporting advocacy and communication initiatives is key.

Let’s collaborate to ensure that these invaluable antibiotics remain effective for friends, family, and future generations who are frequently affected by the challenging burden of cancer.

“Being diagnosed with AML (Acute Myeloid Leukaemia) was no fun! This involved a ten month hospitalisation, during which I contracting Clostridium difficile (C. diff) and learned there was only one antibiotic likely to treat the infection. Luckily it did work and the memory is there to galvanise my efforts to raise awareness of AMR for cancer patients.”

Francesco M. Labricciosa

Francesco M. Labricciosa is a Medical Doctor from Italy. After earning a post-graduate diploma in Primary Care Medicine, he consolidated his experience in different healthcare settings, and then became a specialist in Hygiene and Preventive Medicine.

Antimicrobial Resistance (AMR), optimal and prudent use of antimicrobials, and awareness towards consumption of these medications represent his main fields of interest.

Since 2016, he has been collaborating with the Global Alliance for Infections in Surgery. He participated in several international research projects about prevention and management of healthcare-associated infections, surgical antibiotic prophylaxis, antimicrobial therapy in intra-abdominal infections, and antimicrobial stewardship programs. He has co-authored more than 35 articles published in peer-reviewed medical journals.

Moreover, Francesco works with several medical communication agencies in designing and finalising educational materials aimed at diversified audiences. Finally, he takes an active role in science communication blogging about antimicrobial use and AMR.