Are National Cancer Centers Prepared to Deliver Climate-Smart, Resilient Healthcare? An Overview and Analysis of Organizations' Sustainability Plans

Abstract

<h3>Purpose/Objective(s)</h3> Climate change will be the greatest global health threat of the 21st century. The impact on human health is well-documented and expected to increase if mitigation efforts remain inadequate. The health care sector and oncologists are on the front line of this crisis with vulnerable and marginalized patients bearing the burdens of a changing climate. Equally important, healthcare significantly contributes to greenhouse gas (GHG) emissions. In the U.S., healthcare is responsible for nearly 8.5% of GHG emissions and the loss of 388,000 disability-adjusted life-years annually. Cancer care encapsulates a significant portion of hospital resources. Therefore, it is imperative and urgent that cancer centers actively engage in transitioning to delivering climate-smart, resilient healthcare. Today, centers' engagement in sustainability planning remains largely unknown. This comprehensive review reports on the existence of publicly available sustainability plans at National Cancer Institute (NCI) Cancer Centers and their affiliations. <h3>Materials/Methods</h3> An online review of 64 NCI designated Comprehensive/Cancer Centers and affiliated hospitals/universities was performed using standardized search terms to identify organizations' publicly accessible sustainability plans. Quality of the plans was assessed based on the existence of U.S. Environmental Protection Agency (EPA) Scope 1, 2, 3 emissions. Key personnel and hospital leaders were identified and contacted to understand the centers' involvement in affiliated hospital/university plans. Independent t-tests were utilized to assess the relationship between state cancer incidence rates/per capita and the presence of a sustainability plan. <h3>Results</h3> Amongst the 64 Cancer Centers, only two centers (3%) had independent sustainability plans, although 7 (11%) centers mentioned sustainability on their homepage. A total of 55 of the affiliated hospitals/universities had publicly available sustainability plans (36 university, 12 hospital, and 7 joint hospital/university). A majority (77%) of hospitals with plans also had appointed sustainability leadership. In states where a hospital had a sustainability plan, there was a higher cancer incidence rate (p = 0.052), but there were no significant relationships with specific cancer disease sites (breast [p=0.090], colon [p=0.078], lung [p=0.088], prostate [p=0.696]). <h3>Conclusion</h3> Our findings highlight the critical gap in NCI Cancer Centers' involvement in transitioning to environmentally sustainable and resilient healthcare that will be necessary as cancer patients are affected by the imminent changes of climate. While most centers do not independently report on sustainability efforts, the majority (84%) of their affiliations have publicly accessible sustainability plans. Thus, highlighting the opportunity for centers to partner with their affiliated organizations, and together, ensure a future of climate-smart care for all patients and communities.