24.H. Round table: AMR and cancer: cross-cutting priorities for an integrated public health and primary care approach
Authors:   Organised by: EUPHA Infectious diseases section, EUPHA Chronic diseases section, WFPHA,   Chair persons: Julian Mamo – EUPHA-CHR, Elena Petelos - Greece
Published: October 2020

Abstract
Antimicrobial Resistance (AMR) is a threat to global public health, development and sustainability necessitating prompt action. Antimicrobial agents are essential to treat humans and animals, but their irrational use has caused rapid AMR growth. Antibiotics are prescribed as 'prevention' for lack of diagnostics (Dx), particularly Point-of-Care Testing tools (PoCTs) for timely and reliable identification of a bacterial versus a viral infection. Given the lack of inexpensive readily available PoCTs, current care remains inefficient, particularly in terms of integrating public health and primary care (PC). PC represents a natural setting for exchanges with PTs, survivors and healthy individuals alike, and an optimal setting to implement interventions such as behavioural change for rational antibiotic use and vaccination.
Considering the rise in both cancer incidence and AMR, health systems are seriously threatened, the impact extending well beyond the health sector. Cancer PTs represent the highest burden, with AMR compromising the effectiveness of surgery, radiotherapy and chemotherapy. The most common combination treatments result in immunosuppression exposing PTs to infections. This means PTs often develop infections, frequently recurrent, requiring antibiotic treatment; evidence suggests even key diagnostic procedures, e.g. prostate biopsy, are compromised; the risk of infection necessitates prophylactic treatment and/or resulting iatrogenic infections become difficult to manage. Also, modern oncological therapies rely on immunotherapy to an increasingly more important level. Immunotherapy and AMR interactions and interrelationships ought to be further explored.
The effect of AMR on the lives of cancer PTs and carers, along with its impact on health systems is far from being well understood, with commonalities and topic interdependence largely absent from national cancer plans. An in-depth examination of cancer PTs across different settings and countries is needed to better understand which are the most relevant actions and in which settings to implement them. Similarly, the relevance of cancer plans, roadmaps and national efforts, ought to be examined in the context of AMR, incl. the 'One-Health' approach.
The panel will discuss all above mentioned issues, but also attempt to highlight other key considerations that ought to be integrated in national cancer plans, incl. R&D incentives, curbing the use of antibiotics in animals and of their presence in the environment through cross-sectoral priority setting.
The principal objectives of the workshop are to a. examine AMR implications for cancer PTs in a comprehensive manner encompassing PC, and b. inform on the next steps for interdisciplinary, cross-border and cross-sectoral collaboration.
Following five 12-min presentations, the Panel and the Chairs will enter a 30-min discussion. The audience will be able to respond to key propositions and ask questions through an interactive element.

Key messages
Prioritise the development of Dx/PoTCs, PC and public health integration, and the assessment interventions for populations at risk. Involve PC practitioners and patients to rationalise use and raise awareness, invest in interprofessional education, and engage in interdisciplinary and cross-sectoral dialogue.