As two physicians who have devoted our lives to studying cancer, we’re thrilled with President Joe Biden’s “Cancer Moonshot” initiative to halve the disease’s death rate within 25 years. But we worry that it won’t achieve that goal unless we act on a related, lesser-known health crisis.
For many cancer patients who die from this awful disease, their tumors aren’t solely responsible. In many instances, superbugs sicken these patients, who can’t fight off resistant infections due to weakened immune systems — even with the help of antibiotics.
Reducing deaths from cancer requires an equally aggressive strategy for defeating drug-resistant infections.
It does not make sense to treat these two crises as separate. Superbugs are a global health catastrophe that not only accompany the cancer epidemic but make it worse. A new CDC report shows that drug-resistant infections and related deaths increased 15% in hospitals in 2020. Some specific infections jumped by as much as 78%. It’s already estimated that infections are a primary or associated cause of death in roughly 50% of cancer patients, often because these infections are so difficult to treat and we have too few antibiotic options.
Without an effort to neutralize the threat posed by superbugs, these deadly infections will disrupt any progress we make in the fight against cancer.
Superbugs are bacteria and fungi that have developed antimicrobial resistance (AMR) — a naturally occurring defense against the drugs used to kill them.
We’ve seen firsthand how cancer patients are particularly vulnerable to these deadly infections. Time and again, we’ve watched as patients fighting a wide variety of cancers developed bacterial infections that were highly resistant to antibiotics.
Because certain cancers and treatments compromise the body’s immune system, superbugs can prove especially fatal for our patients. The risk of someone with cancer dying from an infection is three times higher than the risk for an individual without cancer — and resistance only heightens that risk.
A drug-resistant infection may also force a cancer patient to halt their treatment altogether. That’s because killing a superbug often requires a long course of antibiotics — and both the superbug and the lengthy course of therapy can limit a patient’s options for cancer therapies.
For example, a young woman with a persistent, drug-resistant abdominal infection might not get the bone marrow transplant she needs to cure her leukemia. For patients undergoing chemotherapy, an infection can delay their treatment while the cancer continues to grow, potentially leading to more complications and worse health outcomes.
For cancer patients requiring organ transplants, like those with liver cancer, fending off superbugs can be especially difficult. To prevent organ rejection, these patients depend on immunosuppressant drugs — medications that weaken the body’s natural defenses against infection, increasing the risk and severity of bacterial and fungal infections.
In short, for cancer patients, the superbug crisis isn’t some far-off threat — it’s a present mortal danger.
Unfortunately, the pipeline for new antibiotics is nowhere near what is needed to meet the challenge of superbugs. At present, there are 64 novel therapies in some stage of clinical development. To put that in perspective, there are more than a thousand drugs in development for treating different types of cancer.
The dearth of new antibiotics results from a disconnect between the economics of drug development and the unique market dynamics for antibiotics. Because antibiotics are meant to be used judiciously to preserve their effectiveness, it’s essentially impossible for companies to earn back the money they’ve invested in researching and developing those medicines using typical volume-based sales.
It’s for this reason that repeatedly antibiotic startups have either declared bankruptcy or left the industry in recent years.
This market failure demands reforms — and fast. The Pioneering Antimicrobial Subscriptions to End Upsurging Resistance (PASTEUR) Act, currently before Congress, is a promising place to start.
The legislation would create a system in which the government purchases a “subscription” from firms for access to new antibiotics, instead of paying per dose. In so doing, PASTEUR would pay for the value of these medicines rather than their volume, giving companies the return on investment they depend on to continue developing new antibiotics.
The fight against cancer is poised to make enormous strides in the coming years — not least because of initiatives like the Cancer Moonshot. Yet without an equally energetic effort to beat back superbugs, too many cancer patients will still lose their lives.
Cynthia L. Sears (email@example.com) is an infectious diseases physician and professor of medicine at the Johns Hopkins School of Medicine. Fyza Yusuf Shaikh (firstname.lastname@example.org) is an oncologist and assistant professor of oncology at the Johns Hopkins School of Medicine.
Read the full op-ed in The Baltimore Sun here.