my entire professional career, spanning nearly four decades, has been in cancer care. On August 12, 2022, at the age of 64, I myself was diagnosed with mantle cell lymphoma, a rare and aggressive type of cancer that affects the immune system and has a very poor prognosis – I was told that survival without treatment would be only eight. weeks.
I was fortunate to have access to Australia’s world-class care. I received chemotherapy and a stem cell transplant, and through World Cancer Day in February 2024 I was in remission.
As for so many cancer patients, daily medications and monthly infusions are now a necessary part of life, and the side effects of treatment are significant: fatigue; brain fog; loss or changes to taste, smell and other senses; edema of the lining of the eye; temperature regulation issues (cold sensitivity due to neuropathy); and loss of appetite.
Among the more serious, however, is a severely weakened immune system, which makes it harder to fight infections. Last summer I contracted an infection caused by a strain of bacteria that has proven resistant to multiple antibiotics.
My experience with antimicrobial resistance (AMR) is not a unique situation. It is, tragically, for so many, is becoming more and more common.
AMR is the ability of bacteria, fungi, viruses and parasites to develop and survive the effects of antimicrobial drugs (antibiotics, antifungals, antivirals and antiparasitic drugs) designed to kill them. This makes it much more difficult to treat the infections caused by these microorganisms, and the infections are therefore more likely to spread.
Quick guide
A general condition
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The human toll of non-communicable diseases (NCDs) is high and rising. These diseases end the lives of approximately 41 million of the 56 million people who die each year – and three quarters of them are in the developing world.
NCDs are simply that; unlike, say, a virus, you can’t catch them. Instead, they are caused by a combination of genetic, physiological, environmental and behavioral factors. The main types are cancers, chronic respiratory diseases, diabetes and cardiovascular diseases – heart attacks and strokes. About 80% are preventable, and all are on the rise, spreading inexorably around the world as aging populations and lifestyles driven by economic growth and urbanization make being unhealthy a global phenomenon.
NCDs, once seen as diseases of the rich, now have a grip on the poor. Disease, disability and death are perfectly designed to create and increase inequality – and being poor makes it less likely that you will be accurately diagnosed or treated.
Investment in tackling these common and chronic conditions that kill 71% of us is incredibly low, while the costs to families, economies and communities are staggeringly high.
In low-income countries, NCDs – typically slow and debilitating diseases – see a fraction of the money needed invested or donated. Attention remains focused on the threats of communicable diseases, but cancer death rates have long surpassed the death toll of malaria, TB and HIV/Aids combined.
‘A Common Condition’ is a Guardian series reporting on NCDs in the developing world: their prevalence, the solutions, the causes and consequences, telling the stories of people living with these diseases.
Tracy McVeigh, editor
As many as one in five cancer patients are hospitalized due to infection, and rely on antibiotics as their main line of defense. If they don’t work and the infection becomes difficult to treat, surgeries and organ transplants become more complicated, treatment can be delayed, and the patient may need to be placed in intensive care for a long period of time, further increasing healthcare costs.
Eventually, the person may die from the infection – when their cancer was curable.
Cancer remains the second leading cause of death worldwide, with 20 million new cases and almost 10 million deaths in 2022. Although this is expected to increase in the coming years due to aging populations, lifestyle changes and other factors – especially in low and middle income countries – we have seen incredible progress in cancer detection and treatment in recent decades.
With routine screening programs and advances in technology, we are able to detect cancers at much earlier stages, even precancerous, when they are much easier to treat successfully. Similar advances in radiotherapy and chemotherapy have made treatments less invasive and more effective. And a better understanding of cancer and our immune systems has led to innovative, targeted treatments – precision medicine, immunotherapy – that further improve people’s chances of survival, even in more advanced stages.
For this reason, most high-income countries, where these technologies are available and accessible, have seen cancer-related deaths drop by up to 30% since the 1990s. And even greater progress is visible on the horizon, thanks to artificial intelligence, mRNA cancer vaccinesand the prospect of detecting multiple cancers at the same time with a single blood test.
AMR threatens to seriously undermine this incredible success in the treatment of cancer. For this reason, the Union for International Cancer Control (UICC) has actively involved its members around the world in the global response to the problem.
The World Health Organization (WHO) says AMR is one of the top 10 global health and development threats facing humanity today. AMR is associated with 4.95 million deaths in 2019 and a reported 1.27 million people died as a direct result of drug-resistant infections. This number could reach 10 million by 2050 without collective action, with AMR having a cumulative cost $100 a ton (£78tn) of economic output by 2050.
Along with cancer, AMR requires urgent and coordinated responses from all stakeholders, including governments, health professionals, researchers, civil society, industry, people living with cancer and their families. AMR is a cross-cutting issue, requiring a multisectoral and multidisciplinary approach based on the “one health” concept of the interconnection of human, animal and environmental health.
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First, prevention: implementing effective infection prevention and control measures, such as maintaining hygiene and sanitation standards, can reduce the spread of resistant infections.
We also urgently need to address abuse and overuse. This happens in medical settings when antibiotics are prescribed unnecessarily, such as for viral infections, or when they are used longer than necessary. Education about the appropriate use and disposal of these medications is also crucial for healthcare providers and patients.
Another example is in agriculture, where antibiotics are often used to promote growth and prevent disease in livestock.
To prevent drug resistance from developing, we need better stewardship and strict guidelines for the prescribing, dispensing and administration of antibiotics in all settings. Surveillance systems are also essential for monitoring antibiotic use and resistance patterns, facilitating data-driven policy decisions.
Finally, because antibiotics and other antimicrobials are designed to be used as little as possible, we need to find new funding models, such as the UK subscription model, to increase investment in research and development to discover new antibiotics and alternative treatments.
Complacency is not an option. We must act decisively to limit antimicrobial resistance and continue advancing the life-saving therapies that give hope to cancer patients like me.
And I consider myself one of the lucky ones. While I’m in remission, the cancer will come back, and I’ll have access to second-line treatment and, if I go back into remission and when the cancer comes back, third-line treatment of the brand new CAR-T therapy.
This experience gave me a deeply personal perspective on the importance of research, and making these treatments and infection control available to everyone.
