Carbon Footprint of Injectable Chemotherapy in France: A Two Phase Life Cycle Assessment from Single Center to Multicenter Practice

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Abstract
Background: Decarbonizing health systems is an urgent global priority, yet evidence on key emission drivers in oncology remains limited. We aimed to quantify the carbon footprint (CF) of injectable chemotherapy in France and identify major contributors across the care pathway.Methods: We conducted a two phase life cycle assessment (LCA). Phase 1 consisted of a process based LCA of three monoclonal antibodies—intravenous pembrolizumab, subcutaneous daratumumab, and pertuzumab–trastuzumab—administered in a Paris hospital, using cradle to grave boundaries including corporate emissions. Sensitivity analyses assessed uncertainty in manufacturing and electricity mix assumptions. Phase 2 applied an averaged LCA model across seven French hospitals to estimate the mean CF per cycle. Emissions were expressed in kg CO₂e per cycle (ISO14040/44; GHG Protocol).Findings: In phase 1, mean emissions per cycle (excluding corporate emissions) were 19·97 kg CO₂e (pembrolizumab), 42·50 kg CO₂e (daratumumab), and 30.76 kg CO₂e (pertuzumab–trastuzumab). Including corporate emissions increased totals substantially (>75% of overall impact). Results were sensitive to manufacturing assumptions, especially for high dose regimens, and electricity mix. Main contributors were pharmaceutical production, patient travel, and hospital preparation. In phase 2, mean CF per cycle across hospitals was 19·92 ± 7·98 kg CO₂e, without pharmaceutical production and corporate emissions. Interpretation: Injectable chemotherapy carries a substantial, context dependent carbon burden, driven mainly by drug production, corporate emissions, and patient travel. Comprehensive supply chain assessment is essential, and targeted clinical, operational, and industrial interventions could reduce emissions of oncology care without compromising quality. Funding: The French National Academy of Pharmacy with the French Society of Clinical Oncology Pharmacy, MSD, Johnson & Johnson, and Roche.