Telemedicine visits for cancer care are not only more convenient and possibly easier to schedule than in-person appointments—they may also be better for the planet. These findings were presented by Andrew Hantel, MD, and colleagues at the 2024 ASCO Annual Meeting (Abstract 1522) and simultaneously published in JAMA Oncology.
Based on an analysis of data from a regional cancer center, the researchers calculated that, nationwide, cancer care that utilizes telehealth and local care would generate 33.1% less greenhouse gas emissions than the traditional model of in-person care—primarily because of reduced travel to medical appointments. The findings suggest that an approach to care adopted during the COVID-19 pandemic can have significant environmental benefits.
Andrew Hantel, MD
“While health care in the United States provides health benefits to many people, it generates substantial amounts of greenhouse gas emissions that drive climate change and inadvertently harm health,” explained Dr. Hantel, a faculty member in the Divisions of Leukemia and Population Sciences at Dana-Farber Cancer Institute who led the study with Gregory Abel, MD, MPH, a senior physician at Dana-Farber Cancer Institute, and Jonathan Slutzman, MD, of Massachusetts General Hospital. “We wanted to explore the potential reductions in emissions that can be achieved with a decentralized approach to cancer care that includes telehealth. To do so, we used data generated during the ‘natural experiment’ of the pandemic, when care shifted from an in-person to a telemedicine-preferred model.”
Analysis Details
The researchers calculated the amount of carbon dioxide emitted per visit-day at Dana-Farber Cancer Institute during two time periods: March to December 2020, when the COVID-19 pandemic prompted the facility to shift largely to telemedicine; and March 2015 to February 2020, when a traditional in-person model was in place. A visit-day was defined as the combined visits a person has at a health-care facility in a single day.
They began by listing all the components of a clinical visit for both in-person and telehealth appointments. For in-person visits, that list included everything that happens from the time a patient leaves home for an appointment until the time they return—such as driving to the hospital, parking the car, taking the elevator to the clinic, using hand sanitizer, using the bathroom, and driving back home. They also factored in the use of electricity for lights and computers—and even the paper that covers the exam room table. Using a variety of databases, they then determined the carbon dioxide emissions associated with each of these.
For telehealth visits, there were far fewer usage aspects to track—they consisted of mainly computer and internet usage by the patient and clinician.
Results
The team found that per visit-day emissions of carbon dioxide at Dana-Farber Cancer Institute were 36.4 kg lower during the telemedicine period than the in-person period—an 81.3% decline. They then calculated what emissions levels during the prepandemic period would have been if telemedicine had been in place and extrapolated it to the whole U.S. population.
They found that CO2 emissions would have been reduced by 75.3 million kg—a 33.1% drop. At the national scale, the 75.3 million kg decline in CO2 corresponds to a modest reduction in human health harms (15.0–47.7 disability adjusted life-years).
The authors noted that the more modest decline on a national level than at Dana-Farber Cancer Institute reflects differences between the national population and those treated at Dana-Farber, such as the higher proportion of patients with rare cancers. Patients with more uncommon cancers often travel further to receive care, resulting in higher emissions levels, explained Dr. Hantel.
"Telemedicine—and decentralized oncology care in general—involves a complex balance of risks and benefits that vary across the population," he noted. "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."
Disclosure: For full disclosures of the study authors, visit coi.asco.org.
