Clinical Carbon Stewardship in Systemic Anticancer Therapy: A Systematic Review of Life-Cycle Greenhouse Gas Emissions and Their Avoidable Sources.

Authors

Abrahim D Durrani, Hooria Noor, Musa Aslam, Hanna A Khan, Ahsan Ahmad, Muhammad Tariq Bakhshi, Shaheer H Shahzad, Zeeshan Ali, Ahmad Iftikhar

Published in

Journal of cancer policy. Pages 100824. Oct 25, 2026. Epub Oct 25, 2026.

Abstract

Cancer care's environmental footprint is increasingly recognised, but evidence on greenhouse gas (GHG) emissions from systemic anticancer therapy remains fragmented across incompatible methodologies, and its integration into clinical and procurement decision-making remains limited. A credible policy agenda must distinguish emissions inherent to necessary care from avoidable ones while protecting outcomes, access, affordability, and equity.
We conducted a systematic review following PRISMA 2020, prospectively registered in PROSPERO (CRD420251168096). Web of Science, PubMed, Embase, and CENTRAL were searched from inception to 20 September 2026 for primary studies quantifying GHG emissions or other life-cycle environmental outcomes of systemic anticancer therapies or their delivery pathways, with re-screening of retrieved records. Findings were synthesised narratively, with structured exploration of between-study variation.
Fifteen studies evaluated cytotoxic production, oral anticancer drugs, endocrine therapy, monoclonal antibodies, immune checkpoint inhibitors, and treatment delivery. Manufacturing was a recurrent hotspot, whereas patient travel dominated where visits were frequent or distant. Lower-waste dosing, shorter treatment duration, decentralised delivery, and supply-chain optimisation reduced modelled emissions. Redispensing unused oral anticancer drugs produced a net burden under base-case quality assurance but benefits under optimised or visual-inspection scenarios. Route changes cannot be assumed lower carbon. Absolute estimates were highly method-dependent, and pembrolizumab interval changes ranged from approximately 1% to 45% across studies using different comparators and boundaries. Estimates were mostly model-based and from high-income settings, and only one study reported clinical outcomes alongside emissions.
Environmental criteria should inform oncology decisions alongside efficacy, safety, affordability, availability, and equity, and never justify withholding indicated treatment. Supportable now are evidence-based dose and duration optimisation where clinical equivalence is established; reducing avoidable drug waste and visits; requiring life-cycle evidence before assuming route or procurement substitutions lower emissions; and transparent manufacturer-level emission reporting. ISO 14040/14044-aligned oncology reporting standards and evidence from low- and middle-income settings are prerequisites for stronger policy.

PMID:
42927789
Bibliographic data and abstract were imported from PubMed on 26 Oct 2026.

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