How to reduce health care’s climate impact? Increase telehealth

Cancer patients often prefer the convenience of video visits over in-person medical visits. A new study reveals another benefit – telehealth reduces greenhouse-gas emissions.

By moving online all oncology visits that need not be done in person and by allowing patients to have blood drawn and other tests and procedures performed at clinics closer to their homes, researchers estimated they could reduce nationwide carbon-dioxide emissions generated as a result of cancer care by 33%, the study published Monday in JAMA Oncology found.

“Tele-medical and decentralized cancer care does provide a large relative reduction in emissions,” said lead author Dr. Andrew Hantel, a Dana-Farber Cancer Institute oncologist. “It’s potentially a gain downstream for human health and planetary health.”

Health care generated 8.5% of U.S. greenhouse gas emissions in 2018, prior research shows. A growing number of health care providers see the climate crisis as a health crisis. They are working to reduce operating-room waste, to find solutions like more eco-friendly asthma inhalers and in general to educate the medical community about the need to conserve resources.

The new study is “a fantastic eye-opener to give credit to the whole idea that health care is a significant emitter of greenhouse gas emissions,” said Dr. Nithya Ramnath, a University of Michigan professor of medicine and oncology chief at the Ann Arbor Veterans Administration Healthcare System.

“As a society, we have to start thinking about everything that can affect climate, and the health care system should not be immune to it,” said Ramnath, who was not involved with the study.

It included nearly 124,000 people receiving cancer care at Dana-Farber in Boston and its satellites across five New England states between May 2015 and December 2020. When the COVID-19 pandemic forced many oncology visits to be conducted over video and phone starting in March 2020, researchers estimated an 81% reduction in carbon-dioxide emissions. The reduction included fewer miles driven as well as less medical waste, hand sanitizer, toilet paper and the like.

Researchers then calculated what greenhouse gas emission levels might have been before the pandemic if telemedicine had been in place and extrapolated to the U.S. population. They calculated that telehealth and the use of clinics closer to people’s homes for oncology could prevent one-third of the emissions.

Until the pandemic, oncology was presumed to require in-person tests and procedures that would minimize the ability to employ telemedicine.

“Everybody thought that you always had to do all those things in person,” Dana-Farber’s Hantel said. But the natural experiment of the pandemic proved that parts of oncology care could be done closer to home and remotely.

Health care providers have been debating the pros and cons of telehealth, whether it improves access or exacerbates health care disparities, he said.

“We know that telehealth is not universally good, as many people experienced in the pandemic,” Hantel said. “Will the benefit of reducing emissions, plus all the other things that we know that telehealth can probably do well for patients, tip the scales a little bit relative to some of the detriments?”

“Every little thing that we do in terms of climate change does add up,” he said.

Some of Ramnath’s patients, especially those who are less tech-savvy, prefer to see her in person, she said. But many enjoy connecting on video from the comfort of their homes.

“I see their significant others. I see their dog or their cat and have a nice social chat with them,” Ramnath said.

The median patient travel distance from Dana-Farber in the study was 7.1 miles, compared to 8.9 miles in the U.S.

But Ramnath’s patients often drive as many as 50 miles to see her in her Ann Arbor office. Video visits save the cancer patients, and often their caregivers, the time it takes to drive, in addition to travel and childcare costs.

Ramnath also likes telehealth because it allows her to reduce the wait time to see new patients who are anxious to talk to her as soon as possible after they are diagnosed with cancer.

She also has been looking at other ways oncology can reduce its greenhouse-gas emissions. In a study published this month in The Lancet Oncology, Ramnath and her colleagues found that they could administer immunotherapy every six weeks, instead of every three weeks, and reduce associated carbon-dioxide emissions by 24%.

 “Intuitively, we think, why would a medication result in the reduction of greenhouse gas emissions?” she asked. “Because everything that goes along with that medicine – the building, the air conditioning, the nursing time, the vials, the papers, the injectable materials, all the medical equipment, they contribute to greenhouse gas emissions.”

Ronnie Cohen is a San Francisco Bay Area journalist focused on health and social justice issues.