Telehealth curbs cancer care-related greenhouse gas emissions

Using telehealth could significantly reduce greenhouse gas (GHG) emissions linked to cancer care visits, new research reveals.

Published in JAMA Oncology, the study explores whether decentralizing cancer care through telehealth could reduce GHG emissions associated with outpatient clinic visits. Healthcare facilities play a significant role in the climate crisis. According to the Commonwealth Fund, the healthcare sector is responsible for 4.6 percent of total GHG emissions worldwide. In the United States, the healthcare system drove emissions up 6 percent from 2010 to 2018.

Researchers from Dana-Farber Cancer Institute, Harvard Medical School, Boston, and Massachusetts General Hospital set out to examine if telehealth use can curb GHG emissions associated with in-person clinic visits.

They performed a retrospective observational study analyzing data for 123,890 patients receiving cancer care at Dana-Farber Cancer Institute between May 2015 and December 2020. The study authors used life cycle assessment methods “to evaluate the environmental impact of a product or process from natural resource extraction to waste disposal.”

They examined carbon dioxide emissions associated with various aspects of clinic visits, including driving to and from the clinic and using electricity for elevators, lights, and computers.

The research team studied the differences in carbon dioxide emitted across two periods: an in-person care model period between May 2015 and February 2020, known as the pre-period, and a telemedicine model period from March to December 2020, called the post-period.

They found that Dana-Farber's per visit-day carbon dioxide emissions reduced by 36.4 kg between the pre-period and post-period, representing an 81.3 percent decline in the telemedicine period compared with the in-person care period.

When demographically matched to 10.3 million people diagnosed with cancer over the same period from the Cancer in North America public dataset, the researchers observed that decentralized telehealth-based care would have reduced national emissions by 75.3 million kg of CO2 equivalents annually, which corresponded to an estimated annual reduction of 15.0 to 47.7 disability-adjusted life-years.

Thus, the researchers concluded that telehealth has “the potential to reduce visit-related emissions by roughly one-third,” translating “to a small but direct reduction in human mortality.”

However, study co-leader Andrew Hantel, MD, a faculty member in the divisions of leukemia and population sciences at Dana-Farber, noted the potential disparities telehealth use could drive in cancer care access.

"Telemedicine, and decentralized oncology care in general, involve a complex balance of risks and benefits that vary across the population," he said in a press release. "On the plus side, they can increase the reach of expert care while reducing travel, time, and cost for patients. But they also have the potential to add rather than replace visits, which may be difficult for older adults and those without good internet connections, and in some cases may reduce clinicians’ ability to appropriately diagnose and treat. Our findings add another layer to this conversation, showing that emissions reduction is an additional benefit of this approach to care."

Still, the study aligns with prior research showing that telehealth-enabled cancer care can positively affect the environment.

A study published in 2023 showed that implementing telehealth within a single-institution National Cancer Institute (NCI)-designated comprehensive cancer center resulted in significant carbon emissions savings.

The study analyzed data from 23,228 patients participating in 49,329 telehealth visits between April 1, 2020, and June 30, 2021. The visits were divided into those occurring among 21,489 patients with a driving time of 60 minutes or less to the clinic and those among 27,840 patients with a commute exceeding 60 minutes.

The researchers found that 424,471 kg and 2.7 million kg of carbon dioxide emissions were saved due to telehealth use among the group who lived within an hour of the cancer center and those with a commute longer than an hour, respectively.