Greening a chemotherapy day ward

Problem space 

What we prescribe saves lives, but how we prescribe damages the planet. Healthcare accounts for approximately 5% of global greenhouse gas emissions, and across health systems approximately 25% of that footprint relates to prescribing practices. In oncology, this reflects the development, transport and administration of systemic anticancer therapies (SACT). 

The work this builds on 

In previous work, our group reviewed over 300 SACT protocols developed by the Irish National Cancer Control Programme (NCCP) to identify modifiable opportunities that could potentially reduce climate toxicity without compromising patient care. Over 1,000 individual opportunities were identified across these protocols, including switching to oral premedications where appropriate, dose banding, vial sharing, and incorporating lifestyle and exercise prescriptions. The identified touchpoints are demonstrated in the attached infographic, which was developed to help prompt these and other sustainability measures. See the data supplement attached below where this infographic has been translated into several languages.  

Our project: Greening a chemotherapy day ward 

This HSE SPARK Innovation Award study is a quality improvement project exploring how we can integrate these identified touchpoints into everyday practice on the chemotherapy day ward at the CUH–UCC Cancer Centre. Focusing on prescribing practices and supportive care interventions, the project aims to: 

1. Integrate sustainability knowledge into prescribing practices in a chemotherapy day ward. 

2. Reduce the environmental impact of practice by implementing some of the touchpoints identified. 

3. Increase awareness of environmentally beneficial lifestyle and exercise prescriptions. 

Work done so far 

Local 

• Patient survey: Exploring patient perspectives on environmentally conscious practices. 

• Healthcare professional survey: sustainability in oncology. 

• 20-day baseline audit of over 600 SACT prescriptions. 

• Assessment of patients’ travel patterns to the hospital and their perceptions of receiving exercise and nutrition advice after diagnosis. 

National 

• Presenting the project at national clinical leads meetings to understand potential barriers and facilitators to integrating these touchpoints into the care pathway. 

• Collaboration with the HSE Climate and Sustainability Programme and with a HSE plastics and cancer working group. 

• Liaising with the Royal College of Physicians in Ireland to amplify the project nationally.  

Looking ahead 

Our primary challenge has been working within a strained healthcare system where sustainability may not always be seen as a priority. More work on the ground is needed to foster interest and optimism across the oncology team. We need to find a way to communicate clearly how our suggestions have the potential to not only improve the care pathway, both for staff and for patients, but also improve our relationship with the environment.

We hope to share more of our findings as the project progresses. If you have any ideas, suggestions or questions, please feel free to reach out to us at: 

Principal Investigator: Seamus.OReilly@hse.ie 

Research Support Officer: Louise.Costello@ucc.ie