S
SACTCheckSustainability module · v0.69.1
← Regimen library
🌍 Sustainability

Sustainable cancer care, without compromising clinical benefit

This module makes the environmental and resource mechanisms around systemic anticancer therapy visible: treatment value, route and administration, treatment attendance, medicines waste, deprescribing and supportive care.

It deliberately does not assign a universal “green” or “red” regimen score. Regimen-level carbon values should only appear when supported by sufficiently robust lifecycle or comparative evidence.

Clinical boundary: sustainability information is secondary to clinical efficacy, safety, patient preference, NCCP treatment criteria, authorised prescribing and individual clinical judgement. It does not recommend withholding, substituting or de-escalating effective treatment for environmental reasons.
Regimen—
Protocol—
Tumour context—
Delivery classificationNot encoded
This context is passed from the Regimen Library. It identifies relevant footprint drivers; it does not calculate a carbon footprint.

How SACTCheck describes sustainability evidence

Separating evidence maturity prevents a mechanistic observation from being presented as a precise carbon estimate.

Measured

Direct lifecycle or carbon measurement relevant to the treatment or delivery pathway.

Modelled

Published comparative modelling using defined assumptions, such as dosing interval or travel scenarios.

Mechanism-supported

A plausible resource-reduction mechanism supported by evidence, without a defensible regimen-level CO₂e value.

Not quantified

The sustainability consideration is relevant but no regimen-specific environmental estimate is assigned.

Six sustainability domains

The visual language focuses on where burden arises and where clinically appropriate optimisation may reduce it.

⚖️

Clinical value & treatment optimisation

Meaningful clinical benefit remains the first requirement.

🔽 De-escalation: shorter duration or lower intensity only when supported by indication-specific evidence.
⚖️ Magnitude of benefit: established clinical-benefit frameworks can contextualise treatment burden.
📅 Interval: evidence-supported longer intervals may reduce treatment attendances and resource use.
Clinical benefit first
💉

Route & administration

Delivery method affects infrastructure, consumables, preparation and chair time.

IV: infusion materials, aseptic preparation, facility use and travel may contribute.
SC: shorter administration may reduce some delivery resources where formulations are clinically equivalent.
Oral: may reduce infusion-related burden, while manufacture, packaging, monitoring and unused medicines remain relevant.
No route is automatically “green”
🚗

Attendance & travel

Repeated journeys and treatment visits are part of the wider care footprint.

📅 Coordinate care: align bloods, clinical review and treatment when clinically appropriate.
🏠 Remote review: use where safe, suitable and supported by the care pathway.
🚗 Avoidable journeys: approved dosing intervals or local delivery pathways may reduce travel.
Patient burden and resource use often align
♻️

Medicines & waste

Preparation and unused drug are practical stewardship targets.

🧪 Vial sharing: may reduce residual drug waste where governance and aseptic systems permit.
📏 Dose banding: can support standardised preparation and waste reduction where locally approved.
🗑️ Unused medicines: minimise avoidable dispensing and use approved return/redispensing pathways where available.
Implementation depends on governance
💊

Medicines optimisation & deprescribing

Environmental benefit is secondary to better medication stewardship.

🔎 Review: identify duplicate, unnecessary or no-longer-beneficial medicines.
🎯 Goals of care: align preventive and supportive medicines with prognosis and treatment goals.
🧾 Prescribing burden: reduce avoidable medicine use while preserving symptom control and essential therapy.
Clinical appropriateness first
🌿

Lifestyle & supportive care

Broader sustainable care is shown separately from regimen carbon assessment.

🏃 Physical activity: evidence-based exercise support where appropriate.
🥗 Nutrition: evidence-based dietary support while actively identifying malnutrition risk.
❤️ Long-term health: smoking cessation, cardiovascular risk and healthy body composition where relevant.
Not part of a regimen CO₂ score

Regimen-level footprint drivers

When opened from a regimen card, SACTCheck uses available catalogue metadata to highlight relevant mechanisms without inferring an overall footprint.

No regimen selected

Open Sustainability from a regimen card to carry the regimen context into this page.

💉 AdministrationRoute-specific burden is shown when a delivery classification is available.
🚗 AttendanceSchedule and treatment-visit intensity can be added as structured regimen metadata over time.
♻️ Medicines stewardshipVial size, dose banding and waste data require pharmacy and governance context.
No overall sustainability score is generated. A regimen can have high clinical value and substantial delivery burden at the same time; the module keeps those concepts separate.

Structured regimen metadata

This is the data foundation for future regimen-specific sustainability analysis. Known fields are shown; missing fields remain explicit and are not guessed.

Readiness is not a carbon score. Metadata completeness only shows how much of the delivery pathway has been structured and sourced.

Optimisation pathway

A simple visual hierarchy for sustainable oncology decisions.

⚖️1. Preserve benefitStart with efficacy, safety, patient goals and evidence.
🔽2. Avoid unnecessary treatmentUse de-escalation only where clinically established.
💉3. Optimise deliveryRoute, formulation, interval and administration resources.
♻️4. Reduce wasteVial sharing, dose banding and medicines stewardship.
🌿5. Support long-term healthExercise, nutrition and appropriate preventive care.

Evidence library

Source-linked references supplied for the sustainability workstream. Two citations remain explicitly flagged for bibliographic verification rather than being silently treated as validated evidence.

⚖️ De-escalation and clinical benefit
De-escalation / oncology resource optimisation
Mechanism-supported evidence
DOI 10.1007/s11845-024-03672-y
ESMO Magnitude of Clinical Benefit Scale
Clinical-benefit framework
DOI 10.1016/j.annonc.2025.04.006
♻️ Vial sharing and dose banding
Vial sharing
Medicines-waste intervention
DOI 10.1016/j.jval.2024.08.006
Dose banding
Preparation / waste optimisation
DOI 10.1056/CAT.25.0416Additional supplied DOI requires verification: 10.1177/107881552251370560
💉 Formulation and sustainable prescribing
Subcutaneous formulations
Comparative treatment-delivery evidence
DOI 10.1200/OP-24-00804
Sustainable prescribing
Healthcare sustainability framework
DOI 10.1016/S2542-5196(24)00230-4
Intravenous versus oral medicines
Route-related prescribing considerations
DOI 10.1136/bmj-2023-075297
💊 Deprescribing
Deprescribing evidence set
Medicines optimisation in cancer and supportive care contexts
Source 1Source 2Source 3Source 4
🌿 Lifestyle medicine and nutrition
Lifestyle medicine
Supportive and survivorship evidence; shown separately from regimen footprint
Source 1Source 2Source 3Source 4Source 5Supplied citation 10.1017/PY25215 requires verification
Diet and cancer
Nutrition and supportive-care evidence
Source 1Source 2Source 3