Decentralization of cancer care could reduce greenhouse gas emissions by one-third
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Key takeaways:
- The decentralization of clinical care could produce one-third less greenhouse gas emissions than traditional in-person care.
- Daily reductions in greenhouse gas emissions from a telehealth model exceeded 80%.
CHICAGO — Telemedicine substantially reduced greenhouse gas emissions associated with travel to in-person clinical visits for cancer care, results from a retrospective study presented at ASCO Annual Meeting showed.
An analysis from researchers at Dana-Farber Cancer Institute revealed cancer care that utilizes telehealth and local clinical care generates approximately one-third less travel-related greenhouse gas emissions than the traditional model of in-person care.
“There’s been a lot of evidence for how climate change harms patients with cancer, and a number of studies over the last 2 years or so have shown, for example, disruptions in patients’ radiation treatment during hurricanes or other storms and how wildfire exposure leads to a 40% increase in death after curative lung cancer surgery,” Andrew Hantel, MD, faculty member in the divisions of leukemia and population sciences at Dana-Farber Cancer Institute, told Healio.
“We’re also providing care that itself produces emissions, and the United States is not doing it in a way that provides good air quality while also producing extra emissions compared with pretty much every other country in the world,” he added. “Our question here was can we do things that change how we provide care, while still providing optimum care for patients, but do it in a way that actually creates less inadvertent harms?”
Background and methodology
Greenhouse gas emissions from health care facilities and operations comprise a large proportion of overall emissions and can disproportionately affect patients with cancer.
Emissions from outpatient cancer care visits are poorly defined, according to researchers, with little data on the ramifications and downstream reduction in negative effects on the environment that could be realized through visit “decentralization,” consisting of telemedicine and local care.
Hantel and colleagues conducted a lifecycle assessment-based study to evaluate different health care delivery models and their impact on generation of greenhouse gas emissions and downstream negative health effects.
They conducted two separate analyses, starting with a retrospective observational study to calculate the difference in greenhouse gas emissions between an in-person cancer care model in effect from May 2015 to February 2020 and a telemedicine-preferred model running from March to December 2020.
The observational cohort included patients receiving care at Dana-Farber Cancer Institute and 20 affiliated facilities.
The adjusted per visit-day difference in emissions between the in-person period (May 2015 to February 2020) and the telemedicine period (March 2020 to December 2020) served as the primary outcome measurement for the observational analysis.
Meanwhile, study investigators developed a national counterfactual model to assess emissions changes between in-person visits and a decentralization approach to cancer care.
Researchers matched the cohort to a national population diagnosed with cancer over the same period using mixed-effects linear modeling, in which they estimated annual changes in disability-adjusted life-years from clinician visit decentralization.
Results
Researchers noted 123,890 unique patients in the Dana-Farber Cancer Institute cohort seen over 1.6 million visit-days, with a median of 6 visit-days per patient.
They estimated 72,554,006 kg CO2 emissions emitted during the study period. Via mixed-effects log-linear regression, they found the adjusted mean absolute reduction in per visit-day emissions between the in-person and telehealth periods to be 36.4 kg CO2 (95% CI, 36.2-36.6), a reduction of approximately 81.3% (95% CI, 80.8-81.7) compared with the baseline model.
The counterfactual emissions estimate for a decentralized care model showed a relative emissions reduction of 33.1% (95% CI, 32.9-33.3) compared with the in-person period.
When demographically matched to the 10.3 million people in the Cancer in North America dataset, researchers noted that decentralized care would have reduced national emissions by 75.3 million kg CO2 annually, corresponding to an estimated annual reduction of 15 to 47.7 disability-adjusted life-years.
Next steps
The results highlight a slight reduction in human mortality if decentralization through telemedicine and local care became more widely implemented in an attempt to reduce cancer care’s greenhouse gas emissions, Hantel said.
Additional studies on similar topics are in progress to investigate different aspects of cancer care and its potential impact on climate change.
“If you think about the clinician visit as kind of the basic unit of cancer care, there’s so much more on top of that, like delivering chemotherapy, delivering radiation, surgeries.... Aspects within each of those can be changed to reduce emissions while still providing the same amount of benefit to patients,” Hantel told Healio. “This is basically a foundation piece that we’re using to put these other things on top of it and say what are these extra contributions, and where can we make changes to better help patients.”
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Hantel A, et al. Abstract 1522. Presented at: ASCO Annual Meeting; May 30–June 4, 2024; Chicago.
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