Greening Ireland’s oncology practice: Reducing climate toxicity and improving sustainability in a national chemotherapy formulary.

e13557 Background: Climate change has been acknowledged by the World Health Organisation (WHO) as a “fundamental threat” to healthcare delivery. However, healthcare now accounts for more than 5% of global emissions. Over 25% of the oncology services contribution to this relates to the development, transport and administration of systemic anticancer therapies (SACT), and represents a modifiable factor. In Ireland, the National Cancer Control Programme (NCCP) determines the standard of care systemic anticancer therapy (SACT) protocols. This study proposes to review existing protocols and assess for and highlight nationally implementable climate toxicity mitigation strategies. Methods: NCCP SACT protocols (available at https://www.hse.ie/eng/services/list/5/cancer/profinfo/chemoprotocols/) were reviewed for impact reduction potential under the following headings: 1) Baseline and regular tests and investigations; 2) Pre-medications; 3) De-escalation, and 4) ESMO Magnitude of Clinical Benefit. Results: A total of N = 333 protocols were reviewed. N = 32 protocols had multiple indications across more than one tumour stream. Overall, N = 702 opportunities were identified where the protocol impact could be reduced, either by consolidation of pre-medication and pre-hydration to oral administration, regimen or investigation de-escalation, dose banding, switching non-oral to equivalent oral SACT alternative or re-considering regimen use where clinical benefit is measured as non-substantial. In addition, there were a further N = 507 opportunities identified where baseline and regular investigations required by the protocol could be incorporated into routine visits, minimising hospital travel and time toxicity to patients. Conclusions: This study considered just one aspect of oncology care in Ireland, the delivery of SACT, and identified over 1200 opportunities across standardised national protocols where associated climate toxicity could be reduced without compromising standard of care. A sustainability matrix to promote identified action points is proposed for inclusion within all protocols and could be used in other jurisdictions. Further work to consider impact reduction opportunities in other areas of cancer care, including radiology and diagnostics should be considered.