Study: Adjusting Cancer Treatment Doses May Lower Climate Impact

A recent study from the University of Michigan Health Rogel Cancer Center highlights that modifying the frequency of a common cancer treatment could significantly reduce greenhouse gas emissions and improve environmental impact without compromising patient survival rates.

Researchers investigated the use of pembrolizumab, an immunotherapy drug, in 7,813 veterans treated through the Veterans Health Administration (VHA). Typically administered intravenously at a standard dose of 200 milligrams every three weeks, this regimen contributes to carbon emissions through patient travel, drug production, and medical waste.

The team evaluated alternative dosing schedules. One scenario involved administering 400 milligrams every six weeks, a dosage already FDA-approved. Another considered doses adjusted according to patient weight, the original FDA-approved method for pembrolizumab. Both approaches are known to produce comparable cancer outcomes to the current three-week dosing regimen and could potentially alleviate the treatment burden on patients.

Their findings revealed that extending the treatment interval from three weeks to six would drastically reduce the number of clinic visits and treatments. Specifically, it would mean 15,000 fewer infusions, 15,000 fewer trips, and a significant reduction in medical waste over a year. This change alone would cut the VHA's greenhouse gas emissions by 200 tons annually. These results have been published in The Lancet Oncology.

Dr. Garth W. Strohbehn, an assistant professor of internal medicine at Michigan Medicine and co-author of the study, emphasized the cumulative impact of these small decisions on both patient care and environmental health. He noted that the reduced emissions could mitigate climate change-related health risks, potentially saving lives beyond just the patient population. The study's model predicts that maintaining the current dosing schedule could result in approximately three additional deaths per year by 2100 due to heightened greenhouse gas emissions.

Strohbehn, also affiliated with the U-M Institute for Healthcare Policy and Innovation and the VA Ann Arbor Center for Clinical Management Research, stressed the broader societal health costs of continued adherence to less environmentally friendly practices. He posed a moral question about whether changes should be made if patient outcomes remain unaffected.

The study also identified patient travel as the primary source of carbon emissions, suggesting that fewer hospital visits could improve patient quality of life while benefiting the environment. The shift to less frequent, weight-based dosing could also result in significant cost savings for the VHA, further supporting the argument for change.

The authors propose several policy measures to support this transition. Payers could offer incentives for environmentally friendly care practices, and professional societies might update guidelines to reflect sustainability considerations. Additionally, implementing environmental report cards for drugs at the time of approval could raise awareness of their ecological impact.

Strohbehn advocates for a critical reevaluation of current practices, encouraging reflection on the broader implications of medical decisions. The study underscores the potential dual benefits of restructured cancer treatment schedules: enhanced environmental sustainability and maintained or improved patient outcomes.

In conclusion, adjusting the frequency of pembrolizumab administration presents a promising opportunity to reduce environmental impact and healthcare costs without compromising the efficacy of cancer treatment. This approach not only benefits patients but also contributes to the global effort to combat climate change.

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