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BACKGROUND:

  • Environmental pollution and climate change threaten public health, worsening chronic disease and presenting novel health threats to patient populations1. These effects may exacerbate health inequities, particularly in low- and middle-income countries in the Global South.
  • External beam radiation therapy (EBRT) – essential for over half of cancer patients2 – yet also contributes to climate change primarily through energy use and resource consumption3, presenting an opportunity to reduce the environmental impacts of oncology.
  • The environmental impact of EBRT in the Global South remains largely unstudied, despite the disproportionate climate burden4 faced by patients and healthcare systems in the region.�

Figure 1. Comparison of environmental impacts per standard EBRT course between Vitta Clinic (Brazil) and 4 U.S. radiation therapy centers across environmental impact categories, including global warming, ozone depletion, and acidification.

Figure 2. Relative contribution of each emission source (building energy use, transit, & supplies) across all ten impact categories at the Vitta Clinic (top) and U.S. institutions (bottom).

Figure 3. Comparison of environmental impacts from medical supplies, transit, and building energy use associated with EBRT at 4 U.S. radiation therapy centers versus the Vitta Clinic.

AIM:

METHODS:

RESULTS:

CONCLUSIONS:

  • A life cycle assessment (LCA) of EBRT for ten cancer disease sites was conducted at a radiation oncology clinic (Vitta Clinic) in Brasília, Brazil
    • Disease sites: breast, central nervous system, gastrointestinal, genitourinary, gynecological, head & neck, hematological, musculoskeletal, skin, thoracic
  • Followed ISO 14040 and 14044 standardized LCA methodology and the frameworks for LCA of EBRT as previously described3
    • Data inputs: medical supply & equipment usage, building energy consumption, and staff & patient travel to/from Vitta Clinic from 2018-2023
    • Analyzed environmental impacts across ten categories (e.g. greenhouse gas emissions, particulate matter air pollution, and carcinogenic potential) using SimaPro software (version 8.5.2.3) and TRACI (version 2.1)
  • Results were compared with a previously-published LCA of EBRT at four representative U.S. healthcare centers (UCSF, Duke, Mt. Sinai, & University of Michigan)

To quantify the environmental impacts of EBRT in Brazil, comparing it to EBRT delivery in the U.S.4 and exploring how resource-efficient practices may improve environmental health outcomes and, ultimately, equity in oncology outcomes and access.

  • EBRT at the Vitta Clinic demonstrated a lower environmental impact in all impact categories compared to EBRT across four U.S. centers (Fig 1)

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  • Transit: Transit was the greatest relative contributor to Vitta’s emissions (Fig 2), though total GHG emissions from staff travel were lower in Brazil than in the U.S. due to shorter distances (Fig 3)
    • Median staff travel: 15 miles/week by public transit at Vitta vs. 48-90 miles/week by car in the U.S.
    • Median Patient Travel at Vitta: 8.75 miles/week

  • Supplies: Supplies contributed more to total impacts at Vitta than at the U.S. clinics across all ten impact categories (Fig 2), but the absolute impact of supplies between the two locations varied across impact categories (Fig 3)

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  • Building Energy: Vitta’s cooling relied solely on hydroelectricity, while U.S. clinics were powered by natural gas and mixed-grid electricity, making building energy the largest U.S. emissions source (74.0% of CO2 emissions vs. 9.3% at Vitta) (Fig 2)
    • At Vitta, Linear accelerators (Linacs) were the primary energy-consuming equipment, with H&N cancer treatments requiring the most energy (862 kWh)
  • These findings provide novel insights into EBRT’s global environmental impact. The Brazilian clinic’s lower holistic environmental impact relative to US clinics highlights the importance of regional context and the potential role of sustainable practices in reducing oncology’s climate impact.

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  • Such strategies not only reduce environmental pollutants but may also lower costs, maximizing resource efficiency and allowing allocation to improving access to care in underserved regions.

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  • Future research should explore scalable, sustainable EBRT models, particularly in publicly funded and rural clinics, to equitably enhance global radiation oncology.

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Figure 2. Relative Emission Sources in Radiation Therapy: Vitta Clinic vs. U.S. Centers

Figure 3. Supply, Transit, and Building Energy-Related Emissions: Vitta Clinic vs. U.S. Centers

  1. University of California, San Francisco, California
  2. VITTA Centro Avançado de Radioterapia, Brazil 
  3. The University of Texas MD Anderson Cancer Center, Houston, Texas

4. University Hospitals, Case Western Reserve University, Cleveland, Ohio

5. St. George’s University School of Medicine, Grenada, West Indies

6. University of Pennsylvania, Philadelphia, Pennsylvania

Katie E. Lichter1, Genevieve S. Silva1, Samuel Avelino2, Chirjiv Anand1, Osama Mohamad3, Katherine Van Loon1, Shearwood McClelland III4, Alyssa Asaro5, Surbhi Grover6�

References:

  1. Romanello, Marina, et al. "The 2024 report of the Lancet Countdown on health and climate change: facing record-breaking threats from delayed action." The Lancet 404.10465 (2024): 1847-1896.
  2. Delaney G, Jacob S, Featherstone C, Barton M. The role of radiotherapy in cancer treatment. Cancer. 2005;104(6):1129-1137. doi:10.1002/cncr.21324
  3. Lichter KE, Charbonneau K, Lewy JR, et al. Quantification of the environmental impact of radiotherapy and associated secondary human health effects: a multi-institutional retrospective analysis and simulation. Lancet Oncol. 2024;25(6):790-801. doi:10.1016/S1470-2045(24)00148-7
  4. Hartinger SM, et al. The 2023 Latin America report of the Lancet Countdown on health and climate change: the imperative for health-centred climate-resilient development. Lancet Reg Health Am. 2024 Apr 23;33:100746. doi: 10.1016/j.lana.2024.100746. PMID: 38800647; PMCID: PMC11117061.

Figure 1. Comparison of Environmental Impacts: Vitta Clinic vs. U.S. Centers

(kg CFC-11 eq)

(kg CO2 eq)

(kg kg O3 eq)

(kg SO2 eq)

(kg N eq)

(CTU)

(CTUh)

(kg PM2.5 eq)

(CTU)

(MJ surplus)

Environmental Impacts of External Beam Radiation Therapy in Brazil: A Comparative Life Cycle Assessment