According to a new analysis from researchers at the University of Michigan Health Rogel Cancer Center, adjusting the frequency of a well-liked cancer treatment could have environmental benefits without compromising cancer survival rates. The study focused on 7,813 veterans undergoing the immunotherapy treatment pembrolizumab through the Veterans Affairs health system.Health Administration. Pembrolizumab is an intravenous treatment that is commonly administered every three weeks at a standard dose of 200 milligrams. Researchers have looked into the environmental impact of patients traveling to and from the clinic for this treatment every three weeks, including the carbon dioxide emissions from transportation, drug manufacturing, and medical waste from the compounding and infusing process.
They also explored other options, such as giving patients 400 milligrams of pembrolizumab every six weeks, a dosage that has been approved by the U.S. Food and Drug Administration.What if patients received a dose based on their weight instead of the standard dose, as originally approved by the FDA for pembrolizumab? Data shows that these approaches can produce cancer outcomes that are as effective as the standard three-week flat dosing and may also lessen the burdens of cancer treatment for patients.
The researchers discovered that for this group of patients, extending treatments to every six weeks instead of every three weeks would have eliminated the need for 15,000 infusions. This would result in 15,000 fewer visits to the clinic and 15,000 fewer incidents of compounding and infusing treatments. Altogether, this change would decrease greenhouse gas emissions.The reduction in carbon emissions from the VHA by 200 tons per year has been documented in a study published in The Lancet Oncology. Dr. Garth W. Strohbehn, the study author and an assistant professor of internal medicine at Michigan Medicine, emphasized the significance of the decisions made during patient consultations. The study also examined the potential impact of reduced carbon emissions on climate change and human health, extending beyond the individual with cancer to the broader population.The model suggests that if pembrolizumab dosing continues at the current rate instead of switching to less-frequent dosing, there will be an increase in greenhouse gas emissions, leading to about three additional deaths per year until 2100 due to rising global temperatures.
“There will likely be individuals not involved in cancer care who will suffer from the way we dose this medication. This doesn’t have to happen,” said Strohbehn, who is also affiliated with the U-M Institute for Healthcare Policy and Innovation and the VA Ann Arbor Center for Clinical Management Research.
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“This is the main point we’re making here: When we choose to provide cancer care in the current manner, there are likely health costs that non-patients in society will have to bear. Should we feel a moral obligation to change our approach if it does not harm the patient in front of us?”
According to researchers, patient transportation to and from appointments was the leading cause of carbon emissions. This indicates that reducing the frequency of infusion treatments could not only benefit the environment but also potentially enhance the quality of life for patients by reducing their need to visit the hospital. The researchers also estimated that The VHA has seen significant cost savings from using alternative dosing regimens, as the total amount of drug used with weight-based doses is lower than the one-size-fits-all approach. This echoes earlier findings from Strohbehn’s team.
The study authors recommend aligning multiple policy actions to facilitate this change. They suggest that payers could develop targeted incentives for environmentally conscious care, and professional societies could alter guidelines with environmental sustainability in mind without impacting patient outcomes. Requiring environmental reporting could also help drive this shift.Smart cards indicating information about specific drugs at the time of approval could potentially raise awareness. Strohbehn stated, “I believe it’s valuable to hold a mirror up to the traditional system and encourage introspection.”
