Transitioning to Environmentally Sustainable, Climate-Smart Radiation Oncology Care

“Transitioning to Environmentally Sustainable Climate-Smart Radiation Oncology Care,” by Lichter et al., IJROBP, 113:915–924, 2022.

Loyal readers of this blog may have noticed an increasing number of posts related to climate change, and the intersection of global warming with health care and medical physics. This is not an accident. I’m growing increasingly worried about the impact of climate change on our society. One way I act to oppose climate change is to write about it (here, here, here). So, I was delighted to read Katie Lichter and her team’s editorial about “Transitioning to Environmentally Sustainable, Climate-Smart Radiation Oncology Care” (International Journal of Radiation Oncology Biology Physics, Volume 113, Pages 915–924, 2022). Their introduction begins (references removed)

Climate change is among the most pressing global threats. Action now and in the coming decades is critical. Rising temperatures exacerbate the frequency and intensity of extreme weather events, including wildfires, hurricanes, floods, and droughts. Such events threaten not only our ecosystems, but also our health. Climate change’s negative effects on human health are slowly becoming better understood and are projected to increase if emissions mitigation remains inadequate. Emerging research notes a disproportionate effect of climate change on vulnerable populations (e.g., older populations, children, low-income populations, ethnic minorities, and patients with chronic conditions, including cancer) who are the least equipped to deal with these outsized effects.

Then Lichter and her coauthors get specific about radiation oncology.

More than half of cancer patients will require radiation therapy (RT) during the course of their illness. As most RT courses are delivered using fractionated external beam radiation (EBRT), patients undergoing EBRT are vulnerable to treatment disruptions from climate events. Notably, disruption of RT treatments due to severe weather events has been shown to affect patient treatment and survival. As radiation oncologists, it is imperative to recognize and further investigate the effects of climate change on health and cancer outcomes and understand the specific vulnerabilities of patients receiving RT to the effects of climate change. We must also advance our understanding of the contribution of radiation oncology as a specialty to green house gas (GHG) emissions, and what measures may be taken in our daily practices to join the international efforts in reducing our negative environmental impact.

Next the authors present their four R’s to address oncology care: reduce, reuse, recycle, rethink. This is sort of an inside joke among radiation biologists, because radiation biology famously has its own four R’s: repair, reassortment, reoxygenation, and repopulation. Lichter et al.’s four R’s explain how to lower radiation oncology’s effect on the climate.

1. Reduce means to lower the energy needs for imaging and therapeutic devices, and to minimize medical waste.
2. Reuse means to favor reusable equipment and supplies (such as surgical gowns) whenever possible.
3. Recycle means to recycle any single-use supplies than cannot be reused. Much now finds its way to urban landfills rather than to recycling centers.
4. Rethink means to reconsider all medical radiation oncology processes and procedures in light of climate change. Can some things be done by telemedicine? Can we reduce the number of fractions of radiation a patient receives so fewer visits to the hospital are required? Can some professional conferences be held virtually rather than in person? Sometimes the answer may be yes and sometimes no, but all these issues need to be reexamined.

Lichter’s editorial concludes (my italics)

The health care system contributes significantly to today’s climate health crisis. All efforts addressing the crisis are important due to their direct emissions reduction potential, and the example they set for the health care system and the patients who need the care. Although the effects of increasing global temperatures on human health are well studied, the effects of health care, and specifically oncology and radiation treatments, on contributing to climate change are not. The radiation oncology community has a unique opportunity to use our technological expertise and awareness to assess and minimize the environmental impact of our care and set the standard for sustainable health care practices for other specialties to emulate. 

Thank you Katie Lichter and your whole team for all the important work that you are doing to fight climate change! Your four R’s—reduce, reuse, recycle, and rethink—apply beyond radiation oncology, and even beyond health care, to all of our society’s activities. Perhaps writers of textbooks such as Intermediate Physics for Medicine and Biology need to reduce, reuse, recycle, and especially rethink how our books impact, and are impacted by, global warming.