Retrospective Study Exemplifies the Environmental and Health Impacts of Decentralizing Cancer Care

Andrew Hantel, MD

Decentralizing cancer care through telemedicine and local care was found to significantly decrease emissions created by cancer care delivery, leading to a reduction in mortality, according to data from a study presented at the 2024 ASCO Annual Meeting.

Investigators at Dana-Farber Cancer Institute (DFCI) in Boston, Massachusetts assessed the greenhouse gas emissions from outpatient cancer care and the potential for reduction in human health harms through health care decentralization. An analysis of emissions changes before and during the COVID-19 pandemic showed an 81.3% (95% CI, 80.81%-81.7%) reduction in emissions per visit-day during the telemedicine period. Investigators also predicted that decentralized care may have reduced national emissions in the United States (US) by 76,171,554 kilograms of carbon dioxide equivalents (kgCO₂e) annually in the pre-pandemic period.

“There are a lot of potential benefits and a lot of potential detriments to doing things like telemedicine or local care. It can potentially provide access to some patients, or it can be harder for other populations, such as older adults or people without broadband access,” according to Andrew Hantel, MD, lead study author and an instructor in Medicine at Harvard Medical School in Boston, Massachusetts.

In an interview with OncLive^®, Hantel, who also serves as a faculty member in the Divisions of Leukemia and Population Sciences at DFCI and the HMS Center for Bioethics, located in Boston, discussed the evaluation of environmental and health impacts of decentralizing cancer care in response to the high emissions generated by US health care, highlighted the findings from this study, and noted that the balance between accessibility and potential harms must be carefully considered during future implementation of these findings.

OncLive: What was the rationale for evaluating the environmental and downstream health impacts of decentralizing cancer care?

Hantel: US health care produces a lot of emissions, and the amount of emissions it produces leads to the same loss of life each year as colon cancer. Because of that, we asked: Although we can provide excellent local care to patients, and although we can provide excellent telemedical care to patients, what happens in terms of the emissions reduction and potential downstream health benefits of doing things like telemedicine? Or [what happens when you] do things like telemedicine, plus decentralized care, which means as local care as possible?

What methods were utilized during your investigation?

We used the natural experiment of the pandemic to see what happened at DFCI for 5 years before the pandemic, when everything was in person, vs during the pandemic, when a lot of [health care services were conducted telemedically], if possible. [Another of our assessments asked:] in that period before the pandemic, what would have happened if we hypothetically make everything as decentralized as possible? How much emissions reduction would there have been if we applied that across the US?

What findings were derived from your investigation?

In the first part of the study, when we looked before vs during the pandemic at DFCI, we found an 81.3% reduction in the number of emissions that happened between the in-person [era of health care] prior to the pandemic and the inter-pandemic, telemedicine-forward care.

When we conducted that hypothetical [analysis] using the most decentralized care that we could deliver in the pre-pandemic period, [emissions were reduced by] approximately one-third when we extrapolated those findings nationally. That led to a reduction equivalent to 76,171,554 kgCO₂e annually. I know that’s a number that a lot of oncologists or people in the oncology field are not familiar with. Therefore, we translated that over to human lives lost, and saw a low number of excess deaths because of those emissions each year. Although the decrease in kgs of CO₂ was large, the amount of health harms from [decentralizing care] was low.

What are the future implications of this study?

There’s real balance in terms of the harms and the benefits. [The potential limitations of decentralized care] may tip the scales when [oncologists] are at equipoise and are not sure [when to implement these practices]. They [may ask]: Is this a good patient to [receive decentralized care]? These findings might tip the scales towards [practicing more decentralized care] because some downstream health harms can happen when we continue to make patients come in and get all their care in person.

Reference

Hantel A, Cernik C, Walsh T, et al. Assessing the environmental and downstream human health impacts of decentralizing cancer care. J Clin Oncol. 2024;42(16):1522. doi:10.1200/JCO.2024.42.16_suppl.1522