A recent study assessing the carbon footprint of a hospital pharmacy’s cytotoxic drug production unit and its main sources of greenhouse gas (GHG) emissions has revealed potential areas for improvement to reduce its global warming impact.
Global health authorities forecast an additional 250,000 annual deaths from climate change between 2030 and 2050. Rising temperatures and extreme weather events are driving higher rates of food- and water-borne illnesses, amongst other conditions.
Paradoxically, the healthcare sector itself contributes substantially to GHG emissions. In France, for example, healthcare facilities account for approximately 38% of healthcare-associated GHG emissions and 8% of the total national GHG emissions. Identifying ways to limit healthcare-related emissions is crucial to the sector’s overall sustainability.
In the first study of its kind, this stark data has prompted a French research team to assess the carbon footprint of a cytotoxic drug production facility, aiming to highlight sustainability concerns within the hospital sector. It builds on previous studies which evaluated the carbon footprint of operating theatres, medical imaging suites, dialysis and endoscopy centres.
Assessing the carbon footprint
A retrospective evaluation was conducted in a French university hospital’s cytotoxic production unit from January to December 2022, covering approximately 51,000 preparations and 24,700 prescriptions.
A multidisciplinary team, including hospital pharmacists and a technician, gathered data on medication usage, single-use items, intravenous solutions, energy consumption, staff transport and waste.
They weighed or inventoried each component, then applied a lifecycle assessment tool and standard emission factors to calculate carbon footprints.
Excluding medications, 51.7 tons of CO2 equivalent (CO2e) emissions were produced per year, equivalent to about five global aircraft journeys. Leading contributors were staff transport (18.5 tons of CO2e, 35.9%), followed by waste (10.9 tons of CO2e, 21.1%), single-use sterile devices (9.4 tons of CO2e, 18.1%), energy use (4.8 tons of CO2e, 9.3%), disposable protective equipment (4.4 tons of CO2e, 8.5%), and solvent bags/bottles (3.7 tons of CO2e, 7.1%).
In 2022, the unit prepared approximately 46,000 licensed antineoplastic therapies. Overall, these drugs generated more than 18,000 tons of CO2e emissions, with five agents – pembrolizumab, daratumumab, nivolumab, durvalumab, and ipilimumab – accounting for around two-thirds of this total.
A sustainability model for cytotoxic drug production
The researchers identified potential areas for improvement to reduce the global warming impact of the cytotoxic drug production unit to be deprescribing of antineoplastic drugs, staff transport reduction using telecommuting or carpooling and rethinking production process to reduce waste.
They have already taken proactive steps based on these findings. Using an NHS sustainability model, the team developed an action roadmap focusing on priority areas of waste management and staff travel.
Next, they will partner with selected French cytotoxic production units to test the roadmap’s feasibility.
However, recognising that medication compounding itself contributes heavily to GHG emissions, the researchers stated: ‘Individual efforts by hospital units will not suffice to improve the matter… the pharmaceutical industry also has to act on the emissions attributable to their sector.’
Reference
Chabane M et al. Carbon footprint of a chemotherapy production unit within a hospital pharmacy: Time for green pharmacy. Journal of Oncology Pharmacy Practice. 2025;0(0).
