Protecting cancer care in the age of antibiotic resistance

2026-01-28

As we mark World Cancer Day 2026 under the theme “United by Unique” we must confront an often-overlooked but critical threat to cancer care: antibiotic resistance. While global efforts rightly focus on expanding access to early diagnosis, treatment, and palliative care, the silent crisis of antibiotic resistance is undermining the very foundation of modern oncology. For millions of cancer patients worldwide—especially those undergoing chemotherapy, surgery, or stem cell transplants - effective antibiotics are not just supportive care; they are lifesaving.

Photo from World Cancer Day website.

The lifeline of antibiotics in cancer treatment

Cancer and its treatments profoundly weaken the immune system. Chemotherapy, radiation, and bone marrow transplants can cause neutropenia – a dangerous drop in white blood cells that leaves patients vulnerable to even minor infections. Infections are among the most common complications in cancer care, and sepsis is a leading cause of intensive care admissions and death among these patients. Alarmingly, nearly 1 in 10 cancer deaths is due to severe sepsis, not the cancer itself (1).

Antibiotics are essential both to prevent and treat these infections. Prophylactic antibiotics reduce the risk of bloodstream infections in immunocompromised patients (2), while timely, effective antibiotic therapy can mean the difference between life and death. One study found that 70% of cancer patients who initially received ineffective antibiotics for bloodstream infections died within a month, compared to less than 20% of those who received appropriate treatment (3).

The lifeline is fraying

Yet, as bacteria become increasingly resistant to existing antibiotics, this lifeline is fraying. Multidrug-resistant infections are more common in cancer patients than in other patient groups, largely due to frequent hospitalizations, prolonged antibiotic use, and invasive procedures (4). In some settings, up to 75% of patients with blood cancers carry carbapenem-resistant bacteria in their gut – a last-resort class of antibiotics (5). When these bacteria cause infection, treatment options vanish, and outcomes plummet.

Burden of cancer and AMR

The burden of both cancer and AMR falls hardest on low- and middle-income countries, where 70% of cancer deaths occur (6). In these settings, lack of access to antibiotics causes more deaths than resistance itself (7). Yet irrational use persists alongside shortages, creating a dual crisis. Solutions must ensure universal access to essential medicines – including both cancer drugs and antibiotics – without compromising stewardship (8).

Opportunities for collaboration

The growing threat of antibiotic resistance in cancer care also highlights clear opportunities for collaboration between the cancer and AMR communities. Both challenges are systemic, long-term, and deeply shaped by how health systems are designed, resourced, and governed.

Infection prevention and control and AMR stewardship

In oncology, preventing and managing infections is already a cornerstone of safe care. Strengthening infection prevention and control, improving diagnostics, and embedding antimicrobial stewardship within cancer services are proven strategies to reduce healthcare-associated infections and improve outcomes for immunocompromised patients. These same interventions are central pillars of effective AMR containment, creating an immediate area of overlap where joint action can protect cancer patients while preserving antibiotic effectiveness.

Drivers of cancer and AMR intersect

Beyond clinical settings, the drivers of cancer and AMR increasingly intersect. Environmental contamination from pharmaceutical waste and agricultural runoff contributes to both carcinogenic exposures and the spread of drug-resistant pathogens. Likewise, unsustainable food systems are linked to increased cancer risk and high levels of antibiotic use in animal production. Addressing these shared upstream determinants through coordinated policy and regulation offers co-benefits for cancer prevention and AMR control.

Opportunities for shared innovation

There are also opportunities for shared innovation. Genomic surveillance platforms used to track tumour mutations can be leveraged to detect resistant infections, enabling faster, more precise treatment decisions. Joint advocacy across cancer and AMR communities can further strengthen the case for reforming antibiotic and oncology drug development models, both of which suffer from market failure and underinvestment in public-interest innovation.

Together for healthier futures

On World Cancer Day 2026, we recognize that we cannot rely on luck or legacy drugs. The 2025 WHO antibiotic pipeline report highlights a shrinking, “fragile” pipeline, with clinical antibacterial agents dropping to 90 from 97 in 2023 (9). Only 15 of these are innovative, and merely 5 target critical resistant pathogens. The report highlights a critical lack of pediatric formulations, oral treatments for outpatient use, and a continued, urgent need for new drugs to fight antibiotic-resistant infections.

By forging alliances between cancer and AMR communities, we can amplify our impact, protect vulnerable patients, and build health systems that are prepared for the challenges of tomorrow. Effective antibiotics are not optional in cancer care – they are essential. And preserving them is a shared responsibility we all must embrace.

References

1) Williams MD et al. Hospitalized cancer patients with severe sepsis: analysis of incidence, mortality, and associated costs of care. Crit Care. 2004;8(5):R291-298 via ReAct Policy Brief, May 2020.

2) Egan G, Robinson PD, Martinez JPD, Alexander S, Ammann RA, Dupuis LL, Fisher BT, Lehrnbecher T, Phillips B, Cabral S, Tomlinson G, Sung L. Efficacy of antibiotic prophylaxis in patients with cancer and hematopoietic stem cell transplantation recipients: A systematic review of randomized trials. Cancer Med. 2019 Aug;8(10):4536-4546. doi: 10.1002/cam4.2395. Epub 2019 Jul 5. PMID: 31274245; PMCID: PMC6712447.

3) Islas-Muñoz B, Volkow-Fernández P, Ibanes-Gutiérrez C, Villamar-Ramírez A, Vilar-Compte D, Cornejo-Juárez P. Bloodstream infections in cancer patients. Risk factors associated with mortality. Int J Infect Dis. 2018 Jun;71:59-64. doi: 10.1016/j.ijid.2018.03.022. Epub 2018 Apr 9. PMID: 29649549.

4) Ariza-Heredia EJ, Chemaly RF. Update on infection control practices in cancer hospitals. CA Cancer J Clin. 2018 Sep;68(5):340-355. doi: 10.3322/caac.21462. Epub 2018 Jul 9. PMID: 29985544; PMCID: PMC7162018.

5) Kumar, Amarjeet; Mohapatra, Sarita; Bakhshi, Sameer1; Mahapatra, Manoranjan2; Sreenivas, V3; Das, Bimal K; Sood, Seema; Kapil, Arti. Rectal Carriage of Carbapenem-Resistant Enterobacteriaceae: A Menace to Highly Vulnerable Patients. Journal of Global Infectious Diseases 10(4):p 218-221, Oct–Dec 2018. | DOI: 10.4103/jgid.jgid_101_17

6) Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018 Nov;68(6):394-424. doi: 10.3322/caac.21492. Epub 2018 Sep 12. Erratum in: CA Cancer J Clin. 2020 Jul;70(4):313. doi: 10.3322/caac.21609. PMID: 30207593.

7) Access to effective antimicrobials: a worldwide challenge, Laxminarayan, Ramanan et al. The Lancet, Volume 387, Issue 10014, 168 – 175

8) Mpundu M, Caputo A, Sjöblom AK, and Cars O. 2022. The impact of antibiotic resistance on cancer treatment, especially in low and middle-income countries, and the way forward. AMR Control Supplement: The Challenge For The Cancer Community. Pp. 46-50

9) Analysis of antibacterial agents in clinical and preclinical development: overview and analysis 2025. Geneva: World Health Organization; 2025. Licence: CC BY-NC-SA 3.0 IGO.