ImportanceGreenhouse 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).ObjectiveTo assess potential reductions in GHG emissions and downstream health harms associated with telemedicine and fully decentralized cancer care.Design, Setting, and ParticipantsThis 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 MeasuresThe adjusted per–visit 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.ResultsOf 123 890 included patients, 73 988 (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–visit 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 RelevanceThis cohort study found that using decentralization through telemedicine and local care may substantially reduce cancer care’s GHG emissions; this corresponds to small reductions in human mortality.

中文翻译：

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评估分散癌症护理对环境和下游人类健康的影响


重要性医疗保健产生的温室气体 (GHG) 排放量巨大，对癌症患者造成的伤害尤为严重。肿瘤护理的核心组成部分——门诊临床医生就诊的排放量没有得到很好的描述，也没有很好地描述通过分散癌症护理的这一方面（即，远程医疗和可能的情况下的当地临床医生护理）可以实现的排放量和人类伤害的减少。目的评估与远程医疗和完全分散的癌症护理相关的温室气体排放和下游健康危害的潜在减少量。设计、设置和参与者这项基于人群的队列研究和使用生命周期评估方法的反事实分析分析了在丹纳法伯癌症研究所接受癌症护理的人员2015 年 5 月至 2020 年 12 月期间以及同期北美癌症 (CiNA) 公共数据集中诊断出患有癌症的人员。数据分析时间为 2023 年 10 月至 2024 年 4 月。 主要结果和措施两个时期之间调整后的每次访问温室气体排放量（以千克二氧化碳 (CO2) 当量计）的差异：个人护理模式时期（2015 年 5 月至 2020 年 2 月；前期）和远程医疗期（2020 年 3 月至 12 月；后期），以及在反事实模型中残疾调整生命年的逐年减少，其中前期护理在全国范围内最大限度地分散。结果在 123 890 名患者中，有 73 988 名患者（59.7 %）为女性，首次诊断时的中位年龄 (IQR) 为 59 (48-68) 岁。患者就诊日数超过 160 万次。在混合效应对数线性回归中，前期和后期每次访问日二氧化碳当量排放量的平均绝对减少量为 36.4 千克（95% CI，36.2-36.6），减少了 81.3%（95% CI，80 。8-81.7）与基线模型相比。在前期的反事实分散护理模型中，相对排放量减少了 33.1%（95% CI，32.9-33.3）。当人口结构与 CiNA 数据集中的 1030 万人相匹配时，分散式护理每年将减少国家排放量 7530 万公斤二氧化碳当量；这相当于预计每年减少 15.0 至 47.7 个伤残调整生命年。结论和相关性这项队列研究发现，通过远程医疗和本地护理实现权力下放可以大幅减少癌症护理的温室气体排放；这相当于人类死亡率的小幅下降。