Department of Pharmacy, Radboud University Medical Center, Nijmegen, the Netherlands.
Department of Environmental Science, Radboud University, Nijmegen, the Netherlands.
JAMA Netw Open. 2024 Oct 1;7(10):e2438677. doi: 10.1001/jamanetworkopen.2024.38677.
Medications are associated with substantial environmental outcomes, yet frequently end up being unused by patients. Waste-minimizing interventions, such as redispensing of quality-approved oral anticancer drugs remaining unused by patients at home, could reduce the environmental footprint of cancer treatment.
To assess the environmental outcomes of redispensing quality-assured oral anticancer drugs and to explore how redispensing could be environmentally optimized.
DESIGN, SETTING, AND PARTICIPANTS: In this quality improvement study, a cradle-to-grave life cycle assessment was performed in the outpatient pharmacy of 4 Dutch hospitals, based on a prospective multicenter trial comprising 1071 patients with a clinical diagnosis of cancer and an active prescription for an oral anticancer drug stored at room temperature from February 1, 2021, to February 1, 2023, with a follow-up of 12 months per patient.
Participants received prescribed oral anticancer drugs with additional quality-assurance materials (ie, seal bags and time-temperature indicators), so the pharmacy could redispense quality-assured drugs based on authenticity, appearance, remaining shelf life, and/or adequate storage.
The estimated environmental outcomes avoided due to waste reduction (ie, production and transport and incineration of redispensed oral anticancer drugs) corrected for outcomes of process burdens (ie, quality assurance materials), quantified in 3 outcome measures: human health damage (disability-adjusted life-years), ecosystems damage (species × year), and climate change (kg of carbon dioxide equivalent [CO2-eq]) per patient per year.
A volunteer sample of 1071 patients (median age, 70 years [IQR, 62-75 years]; 622 men [58.1%]) participated in the intervention. Redispensing oral anticancer drugs was initially associated with an environmental burden, mainly because of the high impact of time-temperature indicators. However, when quality-assurance materials were selectively used for temperature-sensitive oral anticancer drugs (ie, maximum storage temperature of 25 °C), redispensing was environmentally beneficial to human health and ecosystems, providing estimated climate benefits of 1.9 kg (95% CI, 1.4-2.6 kg) of CO2-eq per patient per year.
In this quality improvement study, redispensing unused oral anticancer drugs was found to be a suitable strategy to reduce waste and improve environmental sustainability of cancer treatment after process optimization. Redispensing unused oral anticancer drugs could contribute to sustainability of cancer treatment through reduced costs and environmental outcomes.
药物与大量环境结果相关，但经常最终被患者未使用。减少浪费的干预措施，如重新分配在家中未使用的质量合格的口服抗癌药物，可以减少癌症治疗的环境足迹。
评估重新分配质量合格的口服抗癌药物的环境结果，并探索如何在环境方面优化重新分配。
设计、设置和参与者：在这项质量改进研究中，对 4 家荷兰医院的门诊药房进行了从摇篮到坟墓的生命周期评估，该研究基于一项前瞻性多中心试验，该试验纳入了 1071 名临床诊断为癌症且正在服用口服抗癌药物的患者，这些药物在室温下储存，从 2021 年 2 月 1 日至 2023 年 2 月 1 日，每个患者的随访时间为 12 个月。
参与者接受了规定的口服抗癌药物，额外提供了质量保证材料（即密封袋和时间-温度指示器），以便药房可以根据药物的真实性、外观、剩余保质期和/或适当的储存条件重新分配质量合格的药物。
通过减少浪费而避免的估计环境结果（即重新分配的口服抗癌药物的生产和运输以及焚烧），经过过程负担（即质量保证材料）的结果校正，以 3 个结果衡量标准量化：每个患者每年因残疾调整的生命年（伤残调整生命年）、生态系统损害（物种×年）和气候变化（二氧化碳当量 [CO2-eq] 千克）。
共有 1071 名患者（中位数年龄为 70 岁[IQR，62-75 岁]；622 名男性[58.1%]）参与了干预措施。最初，重新分配口服抗癌药物会带来环境负担，主要是因为时间-温度指标的影响很大。然而，当质量保证材料仅用于对温度敏感的口服抗癌药物（即最大储存温度为 25°C）时，重新分配对人类健康和生态系统有利，每个患者每年的气候效益估计为 1.9 千克（95%CI，1.4-2.6 千克）CO2-eq。
在这项质量改进研究中，发现重新分配未使用的口服抗癌药物是一种合适的策略，可以在优化流程后减少癌症治疗的浪费并提高环境可持续性。重新分配未使用的口服抗癌药物可以通过降低成本和环境结果为癌症治疗的可持续性做出贡献。
