Dr. Honar Cherif: My patients can receive 5-10 courses of antibiotics during their cancer treatment

2020-10-20

Dr. Honar Cherif has worked as a doctor for 29 years in Sweden at Karolinska Institutet and Uppsala University Hospital. In 1991 he worked at a pediatric leukemia ward where he became close to the children being treated for their leukemia. This is when and why he decided he wanted to become a hematologist.

He says: "A worrying development has been reported in many European countries for some years now. Infections caused by multi-resistant bacteria such as MRSA and ESBL do not respond to the broad-spectrum antibiotics we use to manage infections in these immunocompromised patients.

If we get to a point where we can not prevent and treat these serious infections, we will have a very difficult time treating cancer with chemotherapy. This, of course, has catastrophic consequences."

What motivated you to work in cancer care?

– I got my very first placement as an intern physician in a pediatric leukemia ward in 1991. At that time, we stayed in the hospital six days a week. I became close to the children who were being treated for their leukemia and had to experience their suffering with complications of the disease and complications related to the treatment. For example, mortality related to infectious complications was very high because we did not have the broad-spectrum antibiotics available as we have today.

– Hematology is a specialty where you really make a difference for each individual patient. At the same time, a specialty where development progresses every year. Diseases and conditions where we had nothing to offer a few years ago can be treated today and patients are given significantly improved quality of life and survival.

Approximately how many courses of antibiotics are usually given to your patients during their cancer treatment?

– It varies a lot depending on the diagnosis and given chemotherapy. For example, patients with acute leukemia who undergo intensive chemotherapy and then stem cell transplantation may receive up to five to six courses of different antibiotic preparations and different combinations during the treatment journey.

What is the highest number of courses of antibiotics for an individual patient?

– Patients who are in need of intensive and prolonged chemotherapy can have a complicated disease course with multiple disease relapses and infection episodes including bacterial, viral and fungal infections. Some patients may receive more than 5-10 courses of antibiotics.

How often do you as a doctor notice that patients undergoing these treatments and procedures get infected?

– Patients undergoing allogeneic stem cell transplantation experience prolonged severe neutropenia, which means that the vast majority (more than 90%) of these patients develop at least one episode of bacterial infection.

How much do you think this would change if we did not have access to effective antibiotics for preventive use?

– We use antibiotic prophylaxis for those patients who are at highest risk of developing neutropenic fever. Many countries in the world, including many European countries, report a high and increasing prevalence of bacteria that are resistant to these prophylactic drugs. With continued development of resistance, these preparations will become ineffective, which further increases the risk of severe bacterial infections in this vulnerable patient group.

What consequences would lack of access to effective antibiotics have for cancer care?

– A worrying development has been reported in many European countries for some years now. Infections caused by multi-resistant bacteria such as methicillin-resistant Staphylococcus aureus (MRSA) and extended-spectrum beta-lactamase producing (ESBL) bacteria do not respond to the broad-spectrum antibiotics we use to manage infections in these immunocompromised patients. If we get to a point where we can not prevent and treat these serious infections, we will have a very difficult time treating cancer with chemotherapy. This, of course, has catastrophic consequences.

What actors do you think could help create change around the issue?

– Preventing the occurrence of antibiotic resistance is a shared responsibility. All specialties in health care have their role to play – wise and scientific use of antibiotics is crucial. We need to continue research into developing new antibiotics with new mechanisms of action.

What are you most proud of in context of your work?

– That I can make a difference for each individual patient and I as a doctor can alleviate and cure serious illness. It is very rewarding getting direct feedback for the work you do and the feeling that I have made a difference for my patients.

Is there something particular that you hope to accomplish in the future, as a researcher or as a clinician?

– My research area includes infectious complications in patients with hematological diseases. There is still a lot to research and to improve. If we can better prevent and treat these complications, we can undoubtedly improve the results of cancer treatment.