[MA 2023 23] Environmental Impact of Treatments in Gynaecology
Amsterdam UMC, location VUmc and AMC (flexible, in consultation with daily supervisor)
Proposed by: Eva S. Cohen [e.s.cohen@amsterdamumc.nl]
Introduction
The healthcare sector in the Netherlands is responsible for 7% of national greenhouse gas emissions and 13% of the total raw material consumption (metals and minerals).1 A large part of the environmental footprint originates from the supply chain and (surgical) treatments. To accelerate the transition to carbon neutral healthcare, it is pivotal to adapt clinical best practices by taking the environmental outcomes of treatments into account.
The treatment of uterine fibroids presents a care pathway with potentially avoidable environmental impact, where environmental factors could indeed impact clinical decision-making. Uterine fibroids are the most common neoplasms affecting over 70% of women by the onset of menopause and are clinically apparent in about one third of those women. Several treatment options are available ranging from surgical removal of the entire uterus (hysterectomy) to minimally invasive alternatives or medicines.
A recent study in the US showed the significant impact caused by hysterectomies on the environment.2 However, no study has been done on the environmental impact of treatment alternatives in comparison to hysterectomy. The results from this study create possibilities for environmental mitigation strategies and thereby might improve both individual and planetary health.
Description of the SRP Project/Problem The research concerns the data collection and analysis of all materials and processes necessary for the execution of treatments for uterine fibroids (e.g. energy consumption, production and waste of single use and reusable materials, transport to/from hospital by health professionals and patients, impact of anesthetic gases). This includes the calculation of, among other environmental impact categories, the associated carbon footprint. This outcome can then be further assessed in terms of lost years of life. In this manner, we aim to examine the disparity in lost years of life resulting from the environmental impact of treatments, an area where we also address psychological and ethical aspects.
This projects encompasses daily supervision on how to perform a life cycle analysis* and how to write a scientific manuscript on comparative environmental sustainability research in a multidisciplinary team (Gynaecology, Anaesthesiology, Public and Occupational Health). Through this project you will gain insight in the structure of multiple (national) Green Teams and sustainable healthcare programs (Centre for Sustainable Healthcare), understand the relationship between climate change and health, and think about ways to implement pro-environmental strategies in healthcare.
* LCA is a methodology to quantify the environmental impact of a product, process or system within all stages of the lifecycle, i.e. from the extraction of raw materials to production, packaging, transportation, utilization and, ultimately, end-of-life treatments
Research questions
- What is the environmental impact of surgical procedures for uterine fibroids?
- What is the environmental impact of medical treatments for uterine fibroids?
If there is time left, also the following questions may be answered:
- What are the potentially lost years of life caused by the environmental burden these different treatment alternatives?
- What mitigation strategies can be adopted based on the environmental footprint of the care pathway of uterine fibroids?
- What stakeholders would be involved in implementing mitigation strategies resulting from the study outcomes?
Expected results The results of this study will encompass environmental outcomes and potentially lost years of life of different treatments for uterine fibroids. When comparing treatments for uterine fibroids, patients are currently counselled mostly on effectivity and safety. Hospitals and the Dutch government are inclined to look at the cost effectiveness balance. After this research project we will have insight in the environmental burden of different treatments for uterine fibroids and this might spark a shift towards looking at treatment options from a sustainability-(cost-)effectiveness point of view. By implementing environmental footprints in shared decision making, healthcare professionals and patients will be able to choose a well-informed and value-congruent treatment for uterine fibroids.
Time period, please tick at least 1 time period
- November – June (yes)
- May – November (yes)
Contact Daily supervisor:
Name : Eva S. Cohen
Department : Gynaecology and Public and Occupational Health, Amsterdam UMC, location AMC and VUmc
E-mail : e.s.cohen@amsterdamumc.nl
Phone : 0031620181610
Principal Educator:
Name : Wouter J.K. Hehenkamp
Department : Gynaecology, Amsterdam UMC, location AMC and VUmc
E-mail : w.hehenkamp@amsterdamumc.nl
Phone : 0031641220314
References
1 M.A. Steenmeijer et al., RIVM Factsheet Verduurzaming van de zorgsector, 2023. Factsheet: Het effect van de zorgsector op het milieu | RIVM
2 Thiel, C.L., Eckelman, M., Guido, R., Huddleston, M., Landis, A.E., Sherman, J., Shrake, S.O., Copley-Woods, N., Bilec, M.M., 2015. Environmental Impacts of Surgical Procedures: Life Cycle Assessment of Hysterectomy in the United States. Environmental Science & Technology 49, 1779–1786.. doi:10.1021/es504719g