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GLOBAL CANCER INITIATIVES

12 CANCER CONTROL 2021

particular radiation therapy, chemotherapy (4). Infections may

also be related to an immunosuppressed state due to changes in

the immune system caused by some haematologic malignancies

(5). In the case of solid tumours many factors contribute to an

increased risk of infection, including obstructions caused by the

tumour itself and the disruption of natural barriers such as skin

and mucosal membranes (6). Furthermore, surgery, catheters

and other devices used in treatment often increase the risk

of infections (7). Sepsis and Pneumonia are among the most

common causes for admission to intensive care units for cancer

patients. It is estimated that 8.5% of cancer deaths are due to

severe sepsis (8).

AMR and its impact on cancer care outcomes

Antimicrobial resistance is a global public health problem,

especially as antimicrobial treatment options are becoming

limited. Antimicrobial resistance (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). As a result, the medicines

become ineffective and infections persist, increasing the risk

of spread to others. Currently, an estimated 750,000 people

die every year from drug-resistant infections (9).

Although multi-country studies to provide comparable

data on a global level is lacking, several in-country hospital

surveillance studies suggest an increase in AMR in cancer

patients. For example, a study in India showed that 73% of

patients with blood cancers were colonized with carbapenemresistant bacteria in the gut (10).

A 2017 study in Ethiopia,

showed that bacterial infections in cancer patients was 19.4%,

and that multi-drug resistance was not uncommon (11). These

studies indicate that key advances in medicines, including

the newer targeted therapies for cancer patients, could be

undermined by the increasing threat of AMR.

To address the impact AMR has on negative cancer care

outcomes, a series of actions have to be put in place to ensure

that cancer patients have access to the right treatment at the

right time. For this to happen, we need to build strong and

effective partnerships.

Better addressing AMR for improved cancer care

outcomes through partnerships

The critical need to address AMR to improve cancer care

outcomes is finally starting to get the attention it deserves.

However, the current global response is still far from reaching

the scale and urgency required to address the problem of

AMR effectively. For this reason, the Union for International

Cancer Control (UICC), which is one of the oldest and largest nongovernmental organizations dedicated to cancer control,

has prioritized AMR and is committed to addressing this issue

within the cancer community and beyond.

Three priorities for UICC have been identified, which need to

be addressed simultaneously. These are (i) evidence generation

that effectively mobilizes policymakers, (ii) raising awareness

and increasing knowledge within the cancer community and (iii)

uniting the cancer and infectious diseases communities towards

a joint goal in supporting access to affordable medicines and

responsible use of antibiotics (neither overuse nor misuse).

In 2020, UICC and the Wellcome Trust participated in the

London Global Cancer Week (LGCW), an annual event (12)

that provided the ideal platform to bring together experts from

the fields of cancer and AMR to discuss what action needs to be

taken. The objective was to raise awareness on AMR and ensure

its prioritization in the global cancer agenda. At this event,

the UK Government's Special Envoy on AMR, the Norwegian

Cancer Society, the International Society for Paediatric

Oncology (SIOP), the Wellcome Trust and others called for

increased collaboration to raise awareness and ultimately

ensure strategies are in place to control AMR, including access

to and rational use of treatments.

Partnerships to improve and disseminate data on

AMR and cancer care

Review of the existing evidence shows a lack of data on the

impact of AMR on treatment outcomes for cancer patients. A

recent report commissioned by the Wellcome Trust found that

cancer patients who developed drug-resistant infections had

a greater risk of dying and were more likely to need additional

medical support. But the report also mentioned that this

evidence was weak and more systematic research is needed

to quantify the impact of AMR on cancer care outcomes (13).

It is important that clinicians and policymakers know which

negative outcomes including mortality in cancer care are due

to AMR and how often these occur (14). This data is needed

not only to help shape a more comprehensive response at the

political level and clinical level, but to also increase awareness

at grassroot and patient levels (15).

Many initiatives and partnerships are aimed at addressing

AMR, such as the UK's Fleming Fund which supports low- and

middle-income countries (LMICs) with building laboratory and

surveillance capacity to ensure quality data (16). The Fund has

provided training and laboratory equipment to a number of

countries to strengthen national AMR surveillance systems

(17). In 2015, the World Health Organization (WHO) launched

the Global Antimicrobial Resistance and Use Surveillance

System (GLASS) to improve knowledge through surveillance

and research. It is the first global collaborative effort to

standardize AMR surveillance. However, Dr. Abdul Ghafur,

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