MMy entire professional career, spanning nearly four decades, has been in cancer care. On August 12, 2022, at the age of 64, I was diagnosed with mantle cell lymphoma, a rare and aggressive cancer that attacks 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 the best care in Australia. I had chemotherapy and a stem cell transplant, and by World Cancer Day in February 2024, I was in remission.
For many cancer patients, daily medications and monthly infusions are now a necessary part of life. The side effects of treatment are significant: fatigue, brain fog, loss or change in taste, smell and other senses, edema of the conjunctiva, problems with temperature regulation (sensitivity to cold due to neuropathy) and loss of appetite.
One of the most serious, however, is a severely weakened immune system, making it harder to fight off infections. Last summer I got an infection caused by a strain of bacteria that has proven resistant to multiple antibiotics.
My experience with antimicrobial resistance (AMR) is not unique. It is, tragically, becoming more common for many.
AMR is the ability of bacteria, fungi, viruses, and parasites to evolve and survive the effects of antimicrobials (antibiotics, antifungals, antivirals, and antiparasitics) designed to kill them. This makes the infections that these microorganisms cause much harder to treat, and the infections spread more quickly.
The human toll of noncommunicable diseases (NCDs) is enormous and rising. These diseases end the lives of about 41 million of the 56 million people who die each year – and three-quarters of them are in developing countries.
NCDs are simply that; unlike, say, a virus, you can’t catch them. Instead, they’re caused by a combination of genetic, physiological, environmental, and behavioral factors. The main types are cancer, chronic respiratory disease, diabetes, and cardiovascular disease – heart attacks and strokes. About 80% are preventable, and they’re all increasing, spreading inexorably around the world as aging populations and lifestyles fueled by economic growth and urbanization make unhealthy living a global phenomenon.
NCDs, once seen as diseases of the rich, now have a hold on the poor. Disease, disability and death are perfectly designed to create and increase inequality – and being poor makes you less likely to be diagnosed and treated correctly.
There is a staggeringly low investment in tackling these common and chronic diseases, which kill 71% of the population, yet the costs to families, economies and communities are staggering.
In low-income countries, NCDs – typically slow and debilitating diseases – receive only a fraction of the funding needed to treat them. Attention remains focused on the threats of communicable diseases, but cancer mortality rates have long surpassed the death toll from malaria, TB and HIV/AIDS combined.
‘A common condition’ is a Guardian series reporting on non-communicable diseases in developing countries: their prevalence, solutions, causes and consequences, and the stories of people living with them.
Tracy McVeigh, Editor
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A common condition
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The human toll of noncommunicable diseases (NCDs) is enormous and rising. These diseases end the lives of about 41 million of the 56 million people who die each year – and three-quarters of them are in developing countries.
NCDs are just that; unlike, say, a virus, you can’t catch them. Instead, they’re caused by a combination of genetic, physiological, environmental, and behavioral factors. The main types are cancer, chronic respiratory disease, diabetes, and cardiovascular disease – heart attacks and strokes. About 80% are preventable, and they’re all increasing, spreading inexorably around the world as aging populations and lifestyles fueled by economic growth and urbanization make unhealthy living a global phenomenon.
NCDs, once seen as diseases of the rich, now have a hold on the poor. Disease, disability and death are perfectly designed to create and increase inequality – and being poor makes you less likely to be diagnosed and treated correctly.
There is a staggeringly low investment in tackling these common and chronic diseases, which kill 71% of the population, yet the costs to families, economies and communities are staggering.
In low-income countries, NCDs – typically slow and debilitating diseases – receive only a fraction of the funding needed to treat them. Attention remains focused on the threats of communicable diseases, but cancer mortality rates have long surpassed the death toll from malaria, TB and HIV/AIDS combined.
‘A common condition’ is a Guardian series reporting on non-communicable diseases in developing countries: their prevalence, solutions, causes and consequences, and the stories of people living with them.
Tracy McVeigh, Editor
As many as one in five cancer patients are admitted to hospital for an infection, relying on antibiotics as their main line of defense. If they don’t work and the infection becomes difficult to treat, surgery and organ transplants become more complicated, treatment can be delayed, and the patient may need to stay in intensive care for a longer period of time, further increasing healthcare costs.
Ultimately, the person could die from the infection, while the cancer could be cured.
Cancer remains the second leading cause of death worldwide, with 20 million new cases and nearly 10 million deaths in 2022. While this is expected to increase in the coming years due to aging, lifestyle changes and other factors – particularly in low- and middle-income countries – we have seen incredible advances in cancer detection and treatment over the past few decades.
With routine screening programs and advances in technology, we can detect cancers at much earlier stages, even pre-cancerous, when they are much easier to treat successfully. Similar advances in radiotherapies and chemotherapies 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 are further improving 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 deaths fall by 30% since the 1990s. And even greater progress is on the horizon, thanks to artificial intelligence, mRNA cancer vaccines, and the prospect of detecting multiple cancers simultaneously with a single blood test.
AMR threatens to seriously undermine this incredible success in cancer treatment. For this reason, the Union for International Cancer Control (UICC) is actively involving its members around the world in the global response to the problem.
The World Health Organization (WHO) says that AMR is one of the top 10 global health and development threats facing humanity today. AMR has been associated with 4.95 million deaths in 2019 and 1.27 million people reportedly died as a direct result of drug-resistant infections. This number could reach 10 million by 2050 without collective action, with AMR cumulatively $100 trillion (£78 trillion) in economic output by 2050.
Together with cancer, AMR requires urgent and coordinated responses from all stakeholders, including governments, healthcare professionals, researchers, civil society, industry, people living with cancer and their families. AMR is a cross-cutting problem, requiring a multisectoral and multidisciplinary approach based on the “One Health” concept of the interconnectedness of human, animal and environmental health.
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First, prevention: by implementing effective infection prevention and control measures, such as maintaining hygiene and sanitation standards, the spread of resistant infections can be limited.
We also urgently need to address abuse and overuse. This occurs in medical settings when antibiotics are prescribed unnecessarily, such as for viral infections, or when they are used longer than necessary. Education about the proper use and disposal of these medications is also crucial for healthcare providers and patients.
Another example is agriculture, where antibiotics are often used to promote livestock growth and prevent disease.
To prevent drug resistance from developing, we need better management and strict guidelines for prescribing, dispensing and administering antibiotics in all settings. Surveillance systems are also essential for monitoring antibiotic use and resistance patterns, enabling data-driven policy decisions.
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 keep antimicrobial resistance under control and continue to develop the life-saving therapies that give cancer patients like me hope.
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 the cancer comes back again, third-line treatment of the brand new CAR-T therapy.
This experience has given me a very personal perspective on the importance of research and making these treatments and infection control available to everyone.
