Battling Two Fronts: Cancer and Antimicrobial Resistance

Cancer has been man's leading enemy, therefore, the fight against this disease has been crucial to most medical research and global health policies and programs. However, another known but not often emphasized threat still lingers, which is  Antimicrobial resistance (AMR). 

The combination of these two crises presents the prevailing challenges and present the necessity for changes in healthcare approaches. In the 21st century, the global health landscape faces two formidable adversaries: This has been achieved through handling cancer cases and through addressing the issue of antimicrobial resistance (AMR). Although both are formidable, it casts a formidable and challenging landscape undermining healthcare professionals and researchers. These problems should be addressed concurrently with medical importance and part of the need to improve society's health quality.

Understanding Cancer:

Cancer is a condition in which cells divide and grow out of control. It can take several forms and total over a hundred. Cancer is a global health issue, and it is considered a leading cause of death globally, as highlighted by the WHO, whereby it led to nearly 10 million deaths in 2020 alone.

Even if the detection rate of the disease is high and the available treatment methods are effective, the disease remains a health issue of concern because of the nature and intricacies of the disease, as well as the treatment regimes needed to combat the disease.

Advances in Cancer Treatment:

The last few years have shown advancements in cancer treatment in two significant areas of pharmaceuticals which are : Target therapy and Immunotherapy. 

These advancements have boosted the odds of survival and the joy of survival among many patients. However, some issues are still being worked on, like the immunological escape that renders cancer treatments ineffectual and the lack of satisfactory therapies for some forms of cancer.

Understanding Antimicrobial Resistance (AMR):

AMR is a state whereby bacteria, viruses, fungi, and parasites change their properties to the used drugs, thus making previous treatments insufficient and infections challenging to manage. 

The Organisation for World Health (WHO) similarly categorized AMR as one of the top ten acute threats to human survival in the forthcoming years. Misuse of antibiotics in human beings, animals, and agriculture are some of the factors that cause this progress; this results in resistant strains, which move around the different communities and countries rapidly.

Causes and Impact of AMR:

AMR is primarily driven by the overuse and misuse of antibiotics, both in human medicine and agriculture. The rise of multidrug-resistant organisms complicates the treatment of common infectious diseases, leading to more extended hospital stays, higher medical costs, and increased mortality.

The Intersection of Cancer and Antimicrobial Resistance:

Cancer patients are particularly vulnerable to infections due to their weakened immune systems and frequent hospital visits. Antibiotics are often necessary to manage infections, but this can contribute to the development of AMR. Furthermore, cancer treatments such as chemotherapy can suppress the immune system, increasing the risk of diseases and necessitating the use of even more antibiotics.

Chemotherapy and Increased Infection Risk:

Chemotherapy targets rapidly dividing cells, including cancer cells and healthy white blood cells vital for immune defense. This reduction in white blood cells, known as neutropenia, leaves patients highly susceptible to bacterial, viral, and fungal infections. When antimicrobial-resistant pathogens cause these infections, treatment becomes significantly more challenging and often requires more toxic and less effective drugs (Christopeit et al., 2021).

Hospital-Acquired Infections:

Cancer patients frequently require hospitalization, where they are at risk of acquiring healthcare-associated infections (HAIs). Common HAIs include bloodstream infections, pneumonia, and urinary tract infections, which are increasingly resistant to standard treatments. Methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococci (VRE), and multi-drug-resistant Gram-negative bacteria are among the notable culprits (Butler et al., 2022).

The Challenges of Treating Resistant Infections in Cancer Patients

1. Limited Treatment Options: 

The strategies and methods for combating these organisms and their growing resistance are becoming limited. Such a limitation forces healthcare providers to use drugs that have been in circulation for some time now. These drugs are not very effective and are known to have some toxic side effects. A further toxicity of ORTs is that they can exacerbate the side effects of primary treatments experienced by those who already have cancer (Kubeček et al., 2021).

2. Delayed Diagnosis and Treatment: 

Early detection and definition of a resistant infection are essential factors but frequently met with a problem of delayed diagnosis, mainly because of the requirement of other specific tests. This could be the worst time for the patients as they are weak, and their health can quickly worsen. A high likelihood of inefficiency is observed when the empirical treatment, often prescribed while waiting for the results of tests, may become a problem if the organism is resistant when choosing the further treatment strategy (Al et al., 2021).

3. High Costs and Prolonged Hospital Stays: 

Hospitals, for instance, end up offering service for a more extended period and admitting patients into the Intensive Care Unit, not forgetting the costly treatment methods. These increased costs negatively impact the funding of healthcare systems and put much pressure on patients and families. They also prolong the length of stay in the hospital, where the patient is at a higher risk of contracting other diseases, hence developing a vicious cycle (Poudel et al., 2023).

Strategies to Combat Both Fronts.

Infection Prevention: 

It is a cardinal rule of infection control that preventing infections is better than treating the diseases caused by the infections. This can be done by practicing extensive infection control measures in hospitals, including washing hands, proper disinfection and sterilization of the medical equipment, and segregated patient sections for patients with infections. Immunization of the necessary vaccine-preventable illness and antimicrobials for prevention in high-risk patients are some of the measures (Jiang et al., 2020).

Promoting Responsible Antibiotic Use: Antibiotics must be administered according to need and per prescription norms that are well-regulated by healthcare providers. This involves policymakers providing information on the implications of non-adherence to prescriptions and discouraging self-medication (Siachalinga et al., 2022).

Research and Development: 

New antimicrobial agents and other therapies are needed. This entails investing in research and development that could lead to new drugs, therapies, or diagnostic techniques. Finally, seeking other methods apart from antibiotics, like bacteriophage therapy, immunotherapy, and probiotics, may also be a possible way of fighting against resistant infections (Akram et al., 2023).

Global Collaboration: 

AMR is a global phenomenon that must be addressed internationally. Countries need to work together to introduce surveillance programs, exchange information, and open a range of World Action plans. Such bodies as the World Health Organization (WHO) play a significant role in coordinating these measures and giving recommendations on the most effective measures to be taken ( WHO, 2020).

Summary 

Two main areas that are challenging in the current world include the fight against cancer and AMR. Tackling these challenges necessitates a collaborative effort between innovative research, effective health policies, and global partnerships. Thus, addressing both issues at the same time will lead to better patient outcomes, less disease burden, and a healthier tomorrow.

Call to Action 

Governments, healthcare professionals, researchers, and the general public must collaborate. Further funding in research, discovering new cures, and enforcing better healthcare policies are some of the measures that can help combat these significant health risks.

References:

Akram, F., Imtiaz, M., & ul Haq, I. (2023). Emergent crisis of antibiotic resistance: A silent pandemic threat to 21st century. Microbial Pathogenesis, 174, 105923.

Al Saifi, S. A., Al Adawi, B., & Burney, I. (2021). Patterns of bacterial isolates and their resistance to antibiotics in patients with chemotherapy-induced febrile neutropenia at a university hospital. Oman Medical Journal, 36(4), e290.

Butler, M. S., Gigante, V., Sati, H., Paulin, S., Al-Sulaiman, L., Rex, J. H., ... & Beyer, P. (2022). Analysis of the clinical pipeline of treatments for drug-resistant bacterial infections: despite progress, more action is needed. Antimicrobial agents and chemotherapy, 66(3), e01991-21.

Christopeit, M., Schmidt-Hieber, M., Sprute, R., Buchheidt, D., Hentrich, M., Karthaus, M., ... & Maschmeyer, G. (2021). Prophylaxis, diagnosis, and therapy of infections in patients undergoing high-dose chemotherapy and autologous haematopoietic stem cell transplantation. 2020 update of the recommendations of the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Medical Oncology (DGHO). Annals of hematology, 100, 321-336.

Jiang, A. M., Liu, N., Ali Said, R., Ren, M. D., Gao, H., Zheng, X. Q., ... & Tian, T. (2020). Nosocomial infections in gastrointestinal cancer patients: Bacterial profile, antibiotic resistance pattern, and prognostic factors. Cancer Management and Research, 4969-4979.

Kubeček, O., Paterová, P., & Novosadová, M. (2021). Risk factors for infections, antibiotic therapy, and its impact on cancer therapy outcomes for patients with solid tumors. Life, 11(12), 1387.

Poudel, A. N., Zhu, S., Cooper, N., Little, P., Tarrant, C., Hickman, M., & Yao, G. (2023). The economic burden of antibiotic resistance: A systematic review and meta-analysis. Plos one, 18(5), e0285170.

Siachalinga, L., Mufwambi, W., & Lee, I. H. (2022). Impact of antimicrobial stewardship interventions to improve antibiotic prescribing for hospital inpatients in Africa: A systematic review and meta-analysis. Journal of Hospital Infection, 129, 124-143.

World Health Organization (WHO). (2020). Global action plan on antimicrobial resistance. Retrieved from https://www.who.int/antimicrobial-resistance/global-action-plan/en/.

By: Patricia Okwuchi Nneji