Alternative Trastuzumab Dosing Schedules Are Associated With Reductions in Health Care Greenhouse Gas Emissions

Jacobson, Sofia; Kacew, Alec; Knoebel, Randall W; Hsieh, Po-Hung; Ratain, Mark J.; Strohbehn, Garth W.

doi:10.1200/op.23.00227

Cited by 9 publications

(3 citation statements)

References 38 publications

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“…Recently, studies have begun assessing GHG emissions related to care delivery practices. One such analysis found emission reductions of up to 20% for alternative dosing schedules of common breast cancer treatments . To our knowledge, however, emissions related to a central component of oncology care, outpatient clinician visits, have not been well described.…”

Section: Introductionmentioning

confidence: 99%

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Assessing the Environmental and Downstream Human Health Impacts of Decentralizing Cancer Care

Hantel,

Cernik,

Walsh

et al. 2024

JAMA Oncol

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ImportanceGreenhouse gas (GHG) emissions from health care are substantial and disproportionately harm persons with cancer. Emissions from a central component of oncology care, outpatient clinician visits, are not well described, nor are the reductions in emissions and human harms that could be obtained through decentralizing this aspect of cancer care (ie, telemedicine and local clinician care when possible).ObjectiveTo assess potential reductions in GHG emissions and downstream health harms associated with telemedicine and fully decentralized cancer care.Design, Setting, and ParticipantsThis population-based cohort study and counterfactual analyses using life cycle assessment methods analyzed persons receiving cancer care at Dana-Farber Cancer Institute between May 2015 and December 2020 as well as persons diagnosed with cancer over the same period from the Cancer in North America (CiNA) public dataset. Data were analyzed from October 2023 to April 2024.Main Outcomes and MeasuresThe adjusted per–visit day difference in GHG emissions in kilograms of carbon dioxide (CO2) equivalents between 2 periods: an in-person care model period (May 2015 to February 2020; preperiod) and a telemedicine period (March to December 2020; postperiod), and the annual decrease in disability-adjusted life-years in a counterfactual model where care during the preperiod was maximally decentralized nationwide.ResultsOf 123 890 included patients, 73 988 (59.7%) were female, and the median (IQR) age at first diagnosis was 59 (48-68) years. Patients were seen over 1.6 million visit days. In mixed-effects log-linear regression, the mean absolute reduction in per–visit day CO2 equivalent emissions between the preperiod and postperiod was 36.4 kg (95% CI, 36.2-36.6), a reduction of 81.3% (95% CI, 80.8-81.7) compared with the baseline model. In a counterfactual decentralized care model of the preperiod, there was a relative emissions reduction of 33.1% (95% CI, 32.9-33.3). When demographically matched to 10.3 million persons in the CiNA dataset, decentralized care would have reduced national emissions by 75.3 million kg of CO2 equivalents annually; this corresponded to an estimated annual reduction of 15.0 to 47.7 disability-adjusted life-years.Conclusions and RelevanceThis cohort study found that using decentralization through telemedicine and local care may substantially reduce cancer care’s GHG emissions; this corresponds to small reductions in human mortality.

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Section: Introductionmentioning

confidence: 99%

“…One such analysis found emission reductions of up to 20% for alternative dosing schedules of common breast cancer treatments. 5 To our knowledge, however, emissions related to a central component of oncology care, outpatient clinician visits, have not been well described. Transportation is the largest contributor to US GHG emissions.…”

mentioning

confidence: 99%

Assessing the Environmental and Downstream Human Health Impacts of Decentralizing Cancer Care

Hantel,

Cernik,

Walsh

et al. 2024

JAMA Oncol

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show abstract

“…In the article that accompanies this editorial, Jacobson et al 10 attempt to model how we may measure the environmental impact of trastuzumab, a common and extensively used intravenous antineoplastic biologic in the treatment of human epidermal growth factor receptor 2–positive breast cancer. They conduct a rigorous streamlined life cycle analysis using a case-control simulation to estimate the GHG emission footprint of four dosing strategies for delivering trastuzumab.…”

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confidence: 99%

Cancer Prescriptions and Impact on Climate Change: Real or Imagined?

Kohli

2023

JCO Oncol Pract

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Cost-Effective and Sustainable Drug Use in Hospitals: A Systematic and Practice-Based Approach

Zietse,

van der Zeeuw,

Gebbink

et al. 2024

Appl Health Econ Health Policy

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Alternative Trastuzumab Dosing Schedules Are Associated With Reductions in Health Care Greenhouse Gas Emissions

Abstract: Cancer therapy has environmental costs. In this simulation analysis, @garthstrohbehn and colleagues show how less frequent dosing and shorter durations of therapy might improve public health without making patients with cancer worse off.

Cited by 9 publications

References 38 publications

Assessing the Environmental and Downstream Human Health Impacts of Decentralizing Cancer Care

Assessing the Environmental and Downstream Human Health Impacts of Decentralizing Cancer Care

Cancer Prescriptions and Impact on Climate Change: Real or Imagined?

Cost-Effective and Sustainable Drug Use in Hospitals: A Systematic and Practice-Based Approach

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