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Treading lightly – reducing the environmental impact of clinical trials

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by Cancer Research UK | Interview

13 January 2025

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Clinical trial waste

Clinical trials have a significant environmental impact – to combat this some in the community are stepping up to developing tools, educational initiatives, and collaborative networks to make them more sustainable. Miya Choda tracked down some real innovators to find out what they are doing and the difference it is making…

Tools for accountability drive awareness and progress

Lisa Fox

Lisa Fox, Assistant Operations Director at the Clinical Trials and Statistics Unit of The Institute of Cancer Research, London.

Lisa co-developed the Greener Trials Toolkit. The toolkit enables clinical trial managers to pinpoint high-emission activities and implement targeted reductions, addressing the challenge of high carbon footprints and the need to standardise measurement tools in the field.

What motivated you to develop the Greener Trials Toolkit?

Healthcare is a significant contributor to global greenhouse gas emissions, accounting for 4-5%, with clinical trials being part of this total.

To make trials more environmentally friendly, we first need to understand their carbon footprint and identify the major sources of emissions. With colleagues from the University of Liverpool, we received funding from the National Institute for Health and Care Research (NIHR) to develop a method and guidance for carbon footprinting publicly funded clinical trials.

Recently, we also received funding from Wellcome to create an online, open-access database of trial activities and carbon emission factors, together with an associated carbon calculator tool and resources for mitigation strategies for publicly funded trials and trialists.

What have you seen change since using the toolkit?

To date we have footprinted 12 publicly funded trials using the method and guidance. We’re working on collating much more clinical trial data and this includes international collaborations with colleagues in France and South Africa who are adapting the toolkit for use in their countries.

Although the current sample is small, we are beginning to identify important trends. The ‘hotspots’ of emissions vary between trials, indicating the need for a case-by-case approach. Common sources of emissions include the operations of the Clinical Trials Unit (CTU) or sponsor, travel for the trial staff, and patient travel and assessments. These areas are potential targets for reducing emissions in future trials. Additionally, emissions can arise from associated processes and collaborators, such as central laboratories, data science, and long-term storage of records or samples.

At The Institute of Cancer Research Clinical Trials and Statistics Unit (ICR-CTSU) (ICR-CTSU), we are incorporating carbon footprinting into the development stage of new trials and including this information in funding applications wherever we can. By highlighting the carbon footprint to the trial team and funders, we aim to raise awareness and encourage more sustainable practices.

What advice would you give to trial managers adopting more sustainable practices?

Addressing the environmental impact of clinical trials requires coordinated efforts across sectors. We are collaborating with Greener NHS, industry (via the Sustainable Healthcare Coalition industry Low Carbon Clinical Trials group, the iLCCT), funders, patients, policy makers and regulators to align our work. We are also developing tools and resources to make carbon footprinting easier and quicker for publicly funded trialists.

Currently, there are several resources available, which we are compiling on the MRC NIHR TMRP Greener Trials website. These include the NIHR’s carbon reduction guidelines, the UK CRC Monitoring Group’s Greener Monitoring Guidance, the UKTMN Guide to Efficient Trial Management – which has a chapter on sustainability – and our papers describing the carbon footprinting method and guidance. I encourage trial managers to utilise these resources and contact the Carbon in Clinical Trials team for further support or information.

What does the future hold for tools like this?

We are working on building an online toolkit which will be open science, referenced, annotated and free to use. We hope that the toolkit will help calculate the footprint of trials and provide advice on how to reduce the impact of the hotspots identified. We will work hard to align this tool with parallel initiatives ongoing in the pharmaceutical industry, internationally and within the NHS.

Giulia Pellizzari

Education and awareness create culture change

Giulia Pellizzarri is a lecturer and education lead at UCL

Giulia focuses on raising awareness about the connections between environmental changes and human health. Through her teaching, she empowers researchers to integrate sustainability into their work, driving a cultural shift toward greener practices.

Why is education critical for driving sustainability in clinical trials?

It’s essential – it helps clinical trials staff understand the reasons behind new sustainable processes. Without this knowledge, long-term sustainability is hard to achieve. Many healthcare researchers are not fully aware of the links between climate change and health. Educators must spread this message to ensure future medical professionals integrate climate considerations into their work.

How has your work has influenced researchers and professionals to adopt more sustainable practices?

My lectures on climate change and cancer have led three colleagues to include these topics in their teaching programs at UCL. As a result, three more study programs now address climate change and sustainability. Students are increasingly requesting education on these topics, leading to more research projects. I am currently leading two projects: one focused on healthcare professionals’ views on climate change, and the other examining the connection between rising air pollution, worsened by climate change, and the increased incidence of breast cancer in Northern Italy.

What challenges are you addressing by linking environmental degradation to health outcomes?

A major challenge is the cultural perception that medical research is separate from environmental issues. This misconception arises from a lack of knowledge. By educating future doctors and researchers about sustainable practices, we can improve patient outcomes and reduce our environmental impact. If you ask anyone in the medical community, they would rather prevent a disease than cure it. Educating about sustainability helps achieve this goal.

What do you hope the long-term impact of your work will be?

Within the next few years, I hope researchers will need to assess the environmental and social sustainability of their clinical trial proposals. Projects should only proceed if these criteria are met.

I aim for all healthcare professionals to be fully informed about the impact of climate change on health and to promote sustainable practices. Addressing environmental factors like poor air quality is crucial for improving patient outcomes, especially for conditions like lung cancer.

Education is key to spreading urgent climate messages. The University of San Diego mandates that starting in 2024-25, courses must include at least 30% climate-related content, covering areas like scientific foundations and mitigation strategies. I hope other universities will adopt similar requirements.

Emma Darlington - ECMT Research Manager

Practical tools to make sustainability achievable.

Emma Darlington, The Christie NHS Foundation Trust and manages the research of the Experimental Cancer Medicine team.

Emma and members of the Experimental Cancer Medicine Team at The Christie alongside the Digital Cancer Research Team, CRUK National Biomarker Centre, have developed a waste calculator to monitor and reduce excessive plastic and reagent waste in research labs.

What inspired you to focus on waste reduction?

I work within the Experimental Cancer Medicine Team at The Christie, where we recruit patients for early phase trials. We receive packs of consumables for patient visits, including blood bottles, needles, syringes, and plasters. Over the years, we’ve noticed that we receive far more kits than we use, leading to many items expiring or becoming irrelevant and being thrown away.

In 2019, I conducted a waste audit as part of a master’s project and collected significant waste from 10 trials in just 6 weeks. I found that there was no consistent practice for recycling or re-using unused items, so most of it went to landfill. This not only has a direct environmental impact due to waste production but also a significant negative impact from the manufacturing and transport of these unused consumables.

Since then, we’ve been interested in finding ways to reduce this waste. My long-term goal is to reduce the amount of supplies we receive at the source. We have a motivated team, and I’ve set up a clinical trials sustainability working group at The Christie to explore other ways to improve the sustainability of our work.

How has the waste calculator changed lab operations and culture?

The waste calculator allows sites to answer questions about how they manage supplies of consumables, including whether they have processes in place to recycle or re-use them. Based on their answers, we provide advice from our experiences at The Christie. We also collect this information to guide further waste reduction efforts.

In October, we shared the tool with various networks and are starting to receive data. At The Christie, we’ve implemented a ‘kit destruction guide’ that advises research teams on where certain consumables can be re-used within the trust or donated to charity. We’re already receiving boxes of supplies for re-use that would have otherwise been disposed of.

What challenges remain?

In our clinical team, we receive supplies from external providers for trial samples. While we order many supplies, we often have no control over the quantity or timing of deliveries, leading to excess waste. Reducing this waste requires support from suppliers. These supplies are crucial for meeting trial expectations, but by using data we hope to highlight these issues and encourage discussions on improving supply management at the source.

The waste calculator encourages sites to consider waste reduction and improve their processes. The data collected will provide evidence of the issue, facilitating discussions on practical steps to reduce waste at the source while balancing clinical needs.

Kendra Perez-Smith

The power of collaboration

Kendra Perez-Smith is a Translational Support Manager for the Department of Oncology at the University of Oxford.

She has developed the Laboratory Quality and Technical Network (LAB QUTE) – a network of people aiming to bring about change in the way clinical trial waste is handled.

What inspired you to create the network?

LAB QUTE was inspired by the need to address challenges faced by laboratories working independently who might miss opportunities for collaboration and resource optimisation.

LAB QUTE fosters a community where laboratory professionals can connect, share, and learn from each other, aiming to create a sustainable and empowered laboratory network while maintaining high-quality standards and supporting professional growth.

Has the network improved sample collection or trial administration in a sustainable way?

LAB QUTE has enhanced sustainable practices by repurposing consumables from unused clinical trial kits. Laboratories identified surplus items like pipettes, conical tubes, and cryovials, which were redistributed to labs in need, reducing procurement costs and waste.

This initiative, led by the OCTO Translational Support Unit (TSU) at the University of Oxford, minimised environmental impact and contributed to TSU receiving the Gold LEAF award. By integrating sustainability into clinical trial operations, TSU and LAB QUTE demonstrate how collaborative networks can drive meaningful environmental improvements.

What advice would you give to others looking to create similar networks

Start with a clear mission by defining what the network aims to achieve and communicate it effectively to potential members.

Engage laboratories early and Involve laboratory managers, sustainability officers, and staff in the planning process to align goals. Don’t be afraid to tell people about your idea!

Leverage technology. Use digital platforms for communication, knowledge sharing, and ask your department or institute what advertising capabilities they could help with or reach out to similar networks.

Foster collaboration and encourage peer-to-peer learning and partnerships to create a sense of connectedness among members. Laboratories are of course very busy, so we organise afternoon teas at least twice a year where we can meet each other, discuss our labs and practices, and share information. Also be sure to share success stories to motivate members and promote the network’s impact.

Get Involved

Share your insights on sustainability in research by responding to our ongoing Environmental Sustainability Survey (deadline 31 January 2025)

Find out more about the Environmental Sustainability Concordat that CRUK has signed

Read about CRUK’s environmental policy

Miya Choda

Author

Miya Choda

Miya is Environmental Sustainability in Research Intern at CRUK

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