Laetitia Minh Mai Lê

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.

To compare the costs and benefits of an automated-drug dispensing cabinet (ADC) versus traditional floor stock storage (TFSS). A quasi-experimental multicenter study conducted during 2015. A teaching hospital (814 beds) equipped with 43 ADCs and a not-for-profit teaching hospital (643 beds) equipped with 38 TFSS systems, in Paris, France. All the wards of the two hospitals were included in the study. ADC versus TFSS. A composite outcome composed of cost and benefits. The total cost with payback period was substantially higher for the ADCs (574 006€ for 41 ADCs) than TFSS (190 305€ for 30 TFSS systems). The mean number of costly drugs and units were significantly higher for ADCs (P < 0.001). There was no significant difference in the mean number of overall drugs and units. There were significantly fewer urgent global deliveries with ADCs than TFSS units. Nurses' satisfaction with ADCs was high and the prevalence of medication process errors related to ADCs was low. No event due to storage errors was reported for ADCs and nine events were reported for TFSS units. On the contrary, informatic-related events increased with the use of ADCs, as expected. Overall, ADCs are well-established in wards and are particularly appreciated by nurses. A significant difference in the initial investment cost was confirmed, but it must be adjusted over time. This difference is offset in the long-term by gains in preparation time and fewer medication process errors, securing the medication process.

To evaluate the return on investment (ROI) and quality improvement after implementation of a centralized automated-dispensing system after 8 years of use. Prospective evaluation of ROI; before and after study to evaluate dispensing errors; user satisfaction questionnaire after 8 years of use. The study was conducted at a French teaching hospital in the pharmacy department, which is equipped with decentralized automated medication cabinets in the wards. Pharmacy staff (technicians and residents). Implementation of a centralized automated-dispensing robot. The true ROI was prospectively and annually compared to estimated returns calculated after implementation and upgrade of the robot; dispensing errors determined by observation of global deliveries and the satisfaction of users based on a validated questionnaire were evaluated. Following the upgrade, we found little difference for the ROI (+1.86%). The payback period increased by almost 3 years. There was a significant reduction of dispensing errors, from 2.9% to 1.7% (P < 0.001). User satisfaction of the robot by the pharmacy staff was reported (score of 5.52 ± 1.20 out of 7). These systems are worthwhile investments and largely contribute to improving the quality and safety of the medication process.

This study was conducted to evaluate the ability of Raman spectroscopy (RS) to control antineoplastic preparations used for chemotherapy in order to ensure its physical and chemical qualities. Three taxane drugs: cabazitaxel (CBX), docetaxel (DCX) and paclitaxel (PCX) at therapeutic concentration ranges were analyzed using a handheld spectrometer at 785 nm. Qualitative and quantitative models were developed and optimized using a calibration set (n=75 per drug) by partial least square discriminant analysis and regression and validated using a test set (n=27 per drug). All samples were correctly assigned with an accuracy of 100%. Despite optimization, quantitative analysis showed limited performances at the lowest concentrations. The root mean square error of predictions ranged from 0.012 mg/mL for CBX to 0.048 mg/mL for DCX with a minimal coefficient of determination of 0.9598. The linearity range was validated from 0.175 to 0.30 mg/mL for CBX, from 0.40 to 1.00 mg/mL for DCX and from 0.57 to 1.20 mg/mL for PCX. Despite some limitations, this study confirms the potential of RS to control these drugs and also provides substantial advantages to secure the activity for healthcare workers. As a result of its rapidity and the uncomplicated use of a handheld instrument, RS appears to be a promising method to augment security of the medication preparation process in hospitals.