A Q&A with Prof Seamus O'Reilly on the National Green Cancer Clinical Trials initiative at Cancer Trials Ireland

In this invited "SDG3 and Me" Q&A, Prof Seamus O'Reilly discusses the National Green Cancer Clinical Trials initiative at Cancer Trials Ireland and its relevance to the UN's SDG3 and SDG13. Prof O'Reilly is Editor of a new collection on "Sustainability in Oncology" at the journal BJC Reports.
Published in Cancer and Sustainability
A Q&A with Prof Seamus O'Reilly on the National Green Cancer Clinical Trials initiative at Cancer Trials Ireland

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Please introduce yourself and tell us about your organization and your role.

I was Vice Clinical Lead of Cancer Trials Ireland from 2020–2023 and have been Clinical Lead since the beginning of this year. It’s the national organization for coordinating cancer clinical trials in Ireland. 

Target 3.4 of the United Nations’ SDG3 is, by 2030, to “reduce by one third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being. Why is this goal particularly important for you, your organization, and their mission?

Cancer is one of the most common causes of death and half of the people in our community will develop it in their lifetime. It causes significant suffering. Our goal is two-fold – to reduce mortality through better treatments but also, for patients whose cancer we can’t cure, to make sure that they have access to the latest treatments so that they live longer and better lives. 

SDG13 is to “take urgent action to combat climate change and its impacts.” What projects or initiatives is your organization working on that relate to SDG13 and how might they help to achieve the SDG13 targets?

Climate change is the biggest existential threat to human existence. And, if we look at the impact of healthcare, the carbon footprint of US healthcare is the same as the entire carbon footprint of the United Kingdom. The carbon footprint of UK healthcare is the same as the nation of Croatia. The annual carbon footprint of clinical trials globally is half the carbon footprint of Denmark

Data from the NHS net zero project in the UK is very impressive. Year on year, they've had a reduction in their carbon footprint. We need to bring the same into the clinical trials arena and we need to make our systems more resilient to climate change – things like how our hospitals are built, where our data is stored, the supply chains for different medications, and the nutrition of our patients. 

In May 2022, we established the National Green Cancer Clinical Trials initiative at Cancer Trials Ireland. The goal of that was to embed climate awareness and sustainability into the organization. We have a Green Charter which looks at eight areas related to the running of the organization, ranging from what food to order (a vegan sandwich, for example, has half the carbon footprint of one with meat) to the carbon footprint of our pension plans. 

The plan is to become a climate-aware organization. Our health system is not climate-aware, and our patients are suffering because of climate change. 

In what way is climate change affecting cancer patients?

A hundred and thirty million people were displaced between 2016 and 2021 by extreme weather events globally. When we disrupt care, we reduce outcomes. We know historically from patients receiving treatment during Hurricane Katrina that their outcomes were worse because their treatment was interrupted. You can't operate if the hospital is flooded. 

When I talk about climate change at meetings, we often find that when you open the discussion, people will relay events, from within the past six months, about patients not being able to get treatment because of climate change-related events. At one recent meeting, the chairperson said that they had just received word from a patient that, because of flooding, they couldn't get to their cancer treatment on that day. It's becoming more common. 

In the US, there was a study done of 500,000 patients who had been operated on for lung cancer and whether exposure to wildfire during the first year of recovery had an impact on their survival. They found that there was a dramatic reduction in survival in patients who were exposed to a wildfire up to a year after surgery. 

We are at a critical time. The IPCC Sixth Assessment Report, which is led by the United Nations’ Intergovernmental Panel on Climate Change, indicates that the choices and actions implemented in this decade will have impacts now and for thousands of years. The longer we wait to act on climate change, the harder it is going to become. 

What challenges are you facing in ensuring the initiative’s success?

Time is one and the willingness of people to engage and change is another. The anxiety around this topic can lead to feelings of futility and being overwhelmed – that question of what can I do? 

The Covid-19 pandemic presented an immediate threat so everybody stepped up. The threat from climate change is more gradual, multi-layered, and complex. That makes it harder to address. 

It takes a combination of individuals and governments to make change. When the medical community is silent about this, it facilitates political inertia. If there were more ambassadors for climate change in healthcare, it would be easier to effect change. Our politicians would look and see that the medical community is behind this.

 This happened before in Ireland with the smoking ban. It was proposed by the then Minister for Health and his cabinet colleagues objected to it publicly. A press conference was held where the Minister of Health was sitting down and on the screen behind him were the names of all the medical organizations in the country, including trade union groups of health care workers, that supported the smoking ban. There was no debate after that and all dissent stopped. 

What are the relevant measures of success you are using to determine if the goals of the initiative are achieved?

The first success would be engagement by others within our organization. Another is how big of a network we can integrate into and influence. We’re becoming more aware of sustainability initiatives globally. In isolation, we want to achieve very much. As part of a larger collective, we could achieve an awful lot more. 

What other groups would you like to work with to push forward the goals of the initiative?

We’ve reached out to the Institute of Cancer Research in London who have a sustainability calculation for clinical trials. It measures everything from lab studies to patients’ travel and the transport of samples and goods. You can't manage what you can't measure.

 We’re sending a survey to the Breast International Group, which includes over 50 clinical trial organizations in five continents, to look at how we can build a sustainable global breast cancer clinical trials alliance. The group has members all over the world, including Canada, Greece, Spain, and countries across South America. These are people whose patients are being directly affected by climate change. I would hope that, by a collaboration like this, we can achieve a lot more. 

When you are trying to influence things in a positive way, you need information to educate and a story to motivate. The stories that will come from these groups about how their patients are affected will make a difference in terms of getting things done. We need political engagement, and we need to demonstrate that the healthcare community are behind our politicians when they're trying to legislate in a climate-smart way. Having personal stories and testimonies makes a huge difference. 

How important is this issue to you, personally?

The people most responsible for climate change are those born between 1946 and 1964. These are the people who have benefited the most from the fossil fuel economy with better healthcare and quality of life. They are the group that is going to be least affected by climate change, but the group that can do the most about it. They're the people of influence in society, politics, and Fortune 500 companies. 

I'm a member of that age group and I think it's important that we are not silent, but that we convert our voices into action. Life is lived looking forward but appreciated looking backwards and I think that, personally, I don't want to look back and say that I could have done something – that I was in a leadership role and that I just admired the problem.

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