Henry Skinner, PhD, CEO of the AMR Action Fund, discusses how AMR is affecting cancer care across Europe and outlines what can be done about it
In 2022, a 59-year-old father of two with leukaemia was admitted to a hospital in southern England to undergo chemotherapy. He was placed in a specialised isolation room, designed to protect immunocompromised patients from infection. Unbeknownst to him, however, the showerhead in his bathroom was contaminated with the pathogenic bacteria Pseudomonas aeruginosa. He developed an infection soon after and died weeks later.
The extraordinary circumstances of this case, which this summer resulted in the hospital trust being fined £300,000, have rightly drawn scrutiny and headlines. But they also underscore a difficult truth for millions of people living with cancer: bacteria are an omnipresent threat.
Infections are a leading cause of death among people with cancer, implicated in roughly half of cancer deaths, according to Cancer Patients Europe, and the threat is becoming more difficult to manage in the age of antimicrobial resistance.
Managing the threat of infection in cancer patients in the AMR age
Antibiotics are often described as a foundation of modern medicine, rightly so. They have enabled advances in everything from surgery to childbirth to organ transplantation and, of course, cancer care. The Norwegian Cancer Society estimates that one in five cancer patients need antibiotics during their cancer treatment. As one oncologist recently told me, her entire ability to treat a patient’s cancer is “predicated on the idea that antibiotics will both cure and prevent opportunistic bacterial infections throughout their course of care.” But as resistant bacteria proliferate, cancer care is among the first areas of medicine where cracks in the foundation are becoming visible.
While the vulnerability of cancer patients to infection has long been recognised, there has been relatively little large-scale research on how often these infections are resistant to antibiotics. To help address this gap, the AMR Action Fund, of which I am CEO, along with the Union for International Cancer Control, and Becton Dickinson, established the Cancer & AMR Consortium to begin building an evidence base on how antimicrobial resistance affects patients.
Drawing on millions of patient records and more than 1.6 million bacterial samples across both inpatient and outpatient settings in the US, the consortium has published studies showing that people living with cancer face markedly higher rates of antimicrobial resistance than those without cancer across settings. One study in The Lancet Oncology showed that, in outpatient settings, infections by drug-resistant bacteria were between 1.2 and five times higher in cancer patients. A second study, published in Cancer Medicine, showed that hospitalised cancer patients had notably elevated rates of drug-resistant infections compared with hospitalised patients who did not have cancer.
This is an emerging area of research, and data remain sparse, coming from a limited number of studies and geographies. Characterising the prevalence of AMR infections is challenging, as is understanding their contribution to mortality, in part because of how deaths are recorded.
In many cases, infections that play a critical role in a patient’s decline are not consistently captured in official mortality data. If a patient with leukaemia dies after developing a serious bacterial infection, is the cause of death attributed to the cancer or the infection? Further complicating matters is that there may not be sufficient information to determine the causative pathogen of the infection and whether it was resistant to treatment. This remains an ongoing challenge across countries. The United Kingdom has taken steps to improve how antimicrobial resistance is recorded on death certificates, which is one way to help researchers better measure the scale of the problem and prioritise solutions.
But the goal is not simply to count these deaths more accurately. It is to prevent them, and that begins by closing gaps at the bedside. One of the most important is the limited availability and use of rapid and advanced diagnostics. Too often, clinicians are forced to make their best guess about which antibiotic will be effective while waiting for laboratory confirmation of the causative pathogen. These delays can have pernicious consequences, especially among immunocompromised patients. When first-line treatments prove ineffective, the window to intervene narrows, increasing the risk of complications or death. Expanding the use of rapid diagnostics and investing in innovative technologies that can identify pathogens and determine antimicrobial susceptibility in real time is essential to improving patient outcomes.
Action needed
The lack of rapid, precise diagnostics also makes it harder to identify local and regional patterns of resistance across patient populations, reinforcing the very gaps in understanding that continue to hinder effective policy responses. Some patient groups recognise this and are already calling for a more integrated response. Cancer Patients Europe has urged policymakers to embed antimicrobial resistance within national cancer plans, expand the use of rapid diagnostics, and ensure access to effective treatments for vulnerable patients. The Swedish group Cancerfonden has likewise called for prioritising access to diagnostics and antimicrobials and engaging the health workforce on the issue to heighten awareness of the threat.
While improving data and strengthening surveillance are essential, they cannot come at the expense of action in areas where the need is already clear. The pipeline for novel antibiotics remains alarmingly thin, even as resistance continues to rise. Europe has begun to address this challenge with the introduction of a two-pronged pull incentive in the European Commission’s General Pharmaceutical Legislation. The first element, which is structured in the form of transferable exclusivity vouchers, will reward companies that develop urgently needed antimicrobials. The second element, a voluntary subscription model, is intended to both reward innovation and widen access.
But the success of the programme will depend on how policymakers define which therapies qualify, how they value them, and whether they prioritise innovations that address the areas of greatest unmet need. These decisions will shape investment and development for years to come, influencing not only what enters the pipeline, but what antibiotics ultimately reach patients a decade or more from now.
Improving the defences intended to protect cancer patients from infections requires taking the long view. Bacteria are and will always be an unavoidable part of life, present everywhere, including in the very environments in which patients seek care. By all measures, antimicrobial resistance will continue to worsen, with some studies estimating that resistant infections could contribute to 40 million deaths by 2050. Ensuring that effective antibiotics remain a viable foundation under this strain will require sustained investment, smarter policy, and a renewed focus on innovation so that physicians and their patients can be confident these medicines will work when they are needed most.
Please note, this article will also appear in the 27th edition of our quarterly publication.
