16 June 2024

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

(JAMA Oncology; if=28.4)

  • Hantel A, Cernik C, Walsh TP, Uno H, Larios D, Slutzman JE, Abel GA.

  • Correspondence: 

Importance 重要性

Greenhouse 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).



Objective 目的

To assess potential reductions in GHG emissions and downstream health harms associated with telemedicine and fully decentralized cancer care.



Design, setting, and participants 设计、设置和参与者

This 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 measures 主要研究结果

The 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.

调整后的每次就诊日温室气体排放量(以千克二氧化碳(CO2)当量为单位)在两个时期之间的差异:亲自护理模式时期(2015 年 5 月至 2020 年 2 月;前期)和远程医疗时期(2020 年 3 月至 12 月;后期),以及在前期全国范围内最大程度分散护理的反事实模型中,伤残生命调整年的年减少量。


Results 结果

Of 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.

在纳入的 123 890 名患者中,73 988 名(59.7%)为女性,初诊年龄的中位数(IQR)为 59(48-68)岁。患者就诊天数超过 160 万天。在混合效应对数线性回归中,前后期每次就诊日二氧化碳当量排放量的平均绝对值减少了 36.4 千克(95% CI,36.2-36.6),与基线模型相比减少了 81.3%(95% CI,80.8-81.7)。在前期的反事实分散护理模式中,相对排放量减少了 33.1%(95% CI,32.9-33.3)。如果与 CiNA 数据集中的 1030 万人进行人口统计匹配,分散护理每年可使全国排放量减少 7530 万千克二氧化碳当量;估计每年可减少 15.0 至 47.7 个伤残生命调整年。


Conclusions and relevance 结论

This 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.