Question听 Do reductions in greenhouse gas emissions and associated health harms occur with decentralizing cancer care?

Findings听 In this cohort study including 123鈥�890 patients seen over 1.6 million visit days, compared with an in-person鈥損referred care model, a telemedicine preferred鈥揷are model reduced per鈥搗isit day emissions by 81.3%. In a national counterfactual model comparing usual vs decentralized care (telemedicine as well as local site care when possible), there was a 33.1% reduction in emissions, which corresponded to an annual emissions reduction of 75.3 million kilograms of CO₂ equivalents, or 15.0 to 47.7 disability-adjusted life-years.

Meaning听 Decentralizing oncology care can meaningfully reduce emissions and modestly reduce human health harms.

Importance听 Greenhouse gas (GHG) emissions from health care are substantial and disproportionately harm persons with cancer. Emissions from a central component of oncology care, outpatient clinician visits, are not well described, nor are the reductions in emissions and human harms that could be obtained through decentralizing this aspect of cancer care (ie, telemedicine and local clinician care when possible).

Objective听 To assess potential reductions in GHG emissions and downstream health harms associated with telemedicine and fully decentralized cancer care.

Design, Setting, and Participants听 This population-based cohort study and counterfactual analyses using life cycle assessment methods analyzed persons receiving cancer care at Dana-Farber Cancer Institute between May 2015 and December 2020 as well as persons diagnosed with cancer over the same period from the Cancer in North America (CiNA) public dataset. Data were analyzed from October 2023 to April 2024.

Main Outcomes and Measures听 The adjusted per鈥搗isit day difference in GHG emissions in kilograms of carbon dioxide (CO₂) equivalents between 2 periods: an in-person care model period (May 2015 to February 2020; preperiod) and a telemedicine period (March to December 2020; postperiod), and the annual decrease in disability-adjusted life-years in a counterfactual model where care during the preperiod was maximally decentralized nationwide.

Results听 Of 123鈥�890 included patients, 73鈥�988 (59.7%) were female, and the median (IQR) age at first diagnosis was 59 (48-68) years. Patients were seen over 1.6 million visit days. In mixed-effects log-linear regression, the mean absolute reduction in per鈥搗isit day CO₂ equivalent emissions between the preperiod and postperiod was 36.4 kg (95% CI, 36.2-36.6), a reduction of 81.3% (95% CI, 80.8-81.7) compared with the baseline model. In a counterfactual decentralized care model of the preperiod, there was a relative emissions reduction of 33.1% (95% CI, 32.9-33.3). When demographically matched to 10.3 million persons in the CiNA dataset, decentralized care would have reduced national emissions by 75.3 million kg of CO₂ equivalents annually; this corresponded to an estimated annual reduction of 15.0 to 47.7 disability-adjusted life-years.

Conclusions and Relevance听 This cohort study found that using decentralization through telemedicine and local care may substantially reduce cancer care鈥檚 GHG emissions; this corresponds to small reductions in human mortality.