Travel-associated carbon emissions of patients receiving cancer treatment from an urban safety net hospital.

Healthcare transportation, particularly the transportation of patients to access healthcare services, is a significant source of carbon emissions. This study aims to estimate the carbon emissions of patient transportation among patients receiving cancer care at an urban community safety net hospital. We conducted a retrospective study of patients seen at the oncology clinic of an urban community safety net hospital between 1 July 2022 and 30 June 2023. Patients with at least one in-person visit in 1 year, documented home addresses, and oncologic diagnoses were included in the study. The distance between each patient's home address and the hospital was calculated using the Google Map API key and a macro to calculate distance in metres. The total estimated carbon emissions were calculated using the EPA equivalencies calculator. The primary outcome was carbon emissions from patients' round-trip travel from home to hospital. From 1 July 2022 to 30 June 2023, 13,970 visits were made to the oncology clinic. Of these, 8,235 visits made by 1,080 patients met the criteria for inclusion in the final analysis. Of the 8,235 visits recorded, 5,095 (61.8%) were follow-up/laboratory visits. The 1,080 patients who attended the clinic had a mean age of 63.8 years; 700 (64.8%) were male, and 525 (48.6%) were Black or African-American. Breast cancer was the most common diagnosis, accounting for 423 (39.2%) of cancer diagnoses. Each patient travelled 4.8 (0.3-149.3) miles for a one-way trip and 9.6 (0.7-298.6) miles for a round trip to receive cancer care. Approximately 1,520 (280-119,440) g carbon were emitted per patient visit. A total of 79,582 round-trip miles was calculated for the 8,235 visits made by all patients within 1 year, which corresponds to 31,832 kg CO2 emissions equivalent to 35,658 pounds of coal burned, 1,462 propane cylinders used for a home, or 3,872,250 smartphones charged. Travel to receive cancer care is associated with significant carbon emissions and poses a climate and public health risk. Efforts to decrease the overall carbon footprint of cancer treatment are needed to minimise the contributions of cancer treatment to climate change.

Yusuf H ，Gor R ，Saheed RM ，Vegiventi C ，Kumar A ... -  《-》

American Orthopaedic Foot and Ankle Society Annual Meeting All-in-person Attendance Results in Immense Carbon Expenditure.

Professional society conferences are integral to the medical profession. However, airline travel is a major contributor to greenhouse gas production, and the environmental impact of in-person attendance at an orthopaedic conference has yet to be described. With growing concern about the climate crisis, we sought to quantify the carbon footprint of in-person attendance to help potential attendees more consciously consider in-person attendance, inform strategies to minimize greenhouse gas emissions during travel to annual meetings, and increase awareness about and momentum for efforts in orthopaedic surgery to reduce the carbon footprint of society conferences. (1) What was the magnitude of greenhouse gas production resulting from all-in-person 2019 American Orthopaedic Foot and Ankle Society (AOFAS) annual meeting attendance in Chicago, IL, USA? (2) What was the magnitude of greenhouse gas production resulting from the all-virtual 2020 AOFAS annual meeting, and how does it compare with the 2019 AOFAS annual meeting carbon footprint? (3) To what extent could an alternative in-person meeting model with four or seven hubs decrease greenhouse gas production resulting from round-trip air travel compared with the 2019 AOFAS annual meeting? A list of the postal codes and countries of all 1271 registered participants attending the four-day 2019 AOFAS annual meeting in Chicago, IL, USA, was obtained from AOFAS headquarters. The 2019 conference was chosen because it was the last pre-COVID meeting and thus attendance was more likely to resemble that at prepandemic in-person conferences than more recent meetings because of pandemic travel restrictions. We estimated carbon dioxide-equivalent (CO 2 e) production from round-trip air travel using a publicly available internet-based calculator (Myclimate: https://co2.myclimate.org/en/flight_calculators/new ). Emissions produced by the conference venue, car travel, and hotel stays were estimated using published Environmental Protection Agency emission factors. To estimate emissions produced by the all-virtual 2020 AOFAS annual meeting (assuming an equal number of attendees as in 2019), we used the framework published by Faber and summed estimated network data transfer emissions, personal computer and monitor emissions, and server-related emissions. Using the 2019 registrant list, we modeled four-hub and seven-hub in-person meeting alternatives to determine potential decreased round-trip air travel greenhouse gas production. Meeting hub locations were selected by visualizing the geographic distribution of the 2019 registrants and selecting reasonable meeting locations that would minimize air travel for the greatest number of attendees. Registrants were assigned to the nearest hub location. Myclimate was again used to estimate CO 2 e production for round-trip air travel for the hub meeting models. The total estimated emissions of the all-in-person 2019 AOFAS annual meeting (when accounting for travel, conference space, and hotel stays) was 1565 tons CO 2 e (median 0.61 tons per attendee, range 0.02 to 7.7 tons). The total estimated emissions of the all-virtual 2020 meeting (when accounting for network data transfer emissions, personal computer and monitor emissions, and server-related emissions) was 34 tons CO 2 e (median 0.03 tons per attendee). This corresponds to a 97.8% decrease in CO 2 e emissions compared with the in-person conference. The model of a four-hub in-person meeting alternative with meetings in Chicago, Santiago, London, and Tokyo predicted an estimated 54% decrease in CO 2 e emissions from round-trip air travel. The seven-hub meeting model with meetings in Chicago; Washington, DC; Dallas; Los Angeles; Santiago; London; and Tokyo was predicted to diminish the CO 2 e emissions of round-trip air travel by an estimated 71%. The 2019 AOFAS annual meeting had an enormous carbon footprint and resulted in many individuals exceeding their annual allotted carbon budget (2.5 tons) according to the Paris Agreement. Hosting the meeting virtually greatly reduced the annual meeting carbon footprint, and our hub-based meeting models identified potential in-person alternatives for reducing the carbon footprint of conference attendance. Professional societies must consider our responsibility to decarbonizing the healthcare sector by considering innovative approaches-perhaps such as our multihub proposals-to decarbonize carbon-intensive annual meetings without stalling academic progress.

Parker EB ，Bluman A ，Pruneski J ，Soens W ，Bernstein A ，Smith JT ，Bluman EM ... -  《-》

Travel Distance Between Participants in US Telemedicine Sessions With Estimates of Emissions Savings: Observational Study.

Digital health and telemedicine are potentially important strategies to decrease health care's environmental impact and contribution to climate change by reducing transportation-related air pollution and greenhouse gas emissions. However, we currently lack robust national estimates of emissions savings attributable to telemedicine. This study aimed to (1) determine the travel distance between participants in US telemedicine sessions and (2) estimate the net reduction in carbon dioxide (CO2) emissions attributable to telemedicine in the United States, based on national observational data describing the geographical characteristics of telemedicine session participants. We conducted a retrospective observational study of telemedicine sessions in the United States between January 1, 2022, and February 21, 2023, on the doxy.me platform. Using Google Distance Matrix, we determined the median travel distance between participating providers and patients for a proportional sample of sessions. Further, based on the best available public data, we estimated the total annual emissions costs and savings attributable to telemedicine in the United States. The median round trip travel distance between patients and providers was 49 (IQR 21-145) miles. The median CO2 emissions savings per telemedicine session was 20 (IQR 8-59) kg CO2). Accounting for the energy costs of telemedicine and US transportation patterns, among other factors, we estimate that the use of telemedicine in the United States during the years 2021-2022 resulted in approximate annual CO2 emissions savings of 1,443,800 metric tons. These estimates of travel distance and telemedicine-associated CO2 emissions costs and savings, based on national data, indicate that telemedicine may be an important strategy in reducing the health care sector's carbon footprint.

Cummins MR ，Shishupal S ，Wong B ，Wan N ，Han J ，Johnny JD ，Mhatre-Owens A ，Gouripeddi R ，Ivanova J ，Ong T ，Soni H ，Barrera J ，Wilczewski H ，Welch BM ，Bunnell BE ... -  《JOURNAL OF MEDICAL INTERNET RESEARCH》

Sustainability in radiation oncology: opportunities for enhancing patient care and reducing CO(2) emissions in breast cancer radiotherapy at selected German centers.

Bedir A ，Grohmann M ，Schäfer S ，Mäurer M ，Weimann S ，Roers J ，Hering D ，Oertel M ，Medenwald D ，Straube C ... -  《-》

Longitudinal impact of screening colonoscopy on greenhouse gas emissions.

Colonoscopy is the gold-standard screening test for colorectal cancer. However, it has come under scrutiny for its carbon footprint and contribution to greenhouse gas (GHG) emissions compared to other medical procedures. Notwithstanding, screening colonoscopies may have a positive effect on GHG emissions that is unknown. This study estimated the carbon emissions prevented by screening colonoscopies in the U.S. Using the reported number of screening colonoscopies performed annually in the U.S. and the absolute risk reduction (ARR) reported in the NorDICC trial, we calculated the expected minimum number of cancer treatment and surveillance visits prevented through screening based on the cancer stage. The average carbon emission averted per mile traveled was computed using the Environmental Protection Agency's (EPA) GHG equivalencies calculator. The final estimate of carbon emissions averted over a decade by screening colonoscopies performed in one year was determined. 6.3 million screening colonoscopies performed in one year prevent 1,134,000 colorectal cancers over a ten-year period. Of these, 38∙3% (434,254) are localized, 38∙8% (440,281) are regional, and 22∙9% (259,465) are metastatic disease. The minimum number of post-diagnosis visits prevented is 11 for stage I, ≥ 21 for stage II, ≥25 for stage III, and ≥ 20 for stage IV disease, comprised of diagnostic, surgical evaluation, chemotherapy, and surveillance visits. The total number of visits prevented by screening is 2,388,397 for stage I, 5,254,421 for stage II, 13,120,369 for stage III, and 9,210,972 for stage IV disease. Approximately 395 million miles of travel and 158,263 metric tons of CO2, equivalent to 177 million pounds of coal burned, 19 billion smartphones charged, or 18 million gallons of gasoline consumed, were saved over ten years through screening. Colorectal cancer screening decreases cancer-related GHG emissions and minimizes the environmental impact of cancer treatment.

Yusuf H ，Gupta V ，Osaghae I ，Kumar A ... -  《-》