Effect of Radiation Schedule on Transportation-Related Carbon Emissions: A Case Study in Rectal Cancer

PURPOSE: The health care sector is a major contributor of worldwide greenhouse gas (GHG) emissions. Indirect emissions, including those associated with transportation, make up 82% of the US health care sector's environmental footprint. Radiation therapy (RT) treatment regimens present an opportunity for environmental health care–based stewardship owing to the high incidence of cancer diagnosis, significant utilization of RT, and myriad treatment days required for curative regimens. Because the use of short-course RT (SCRT) in the treatment of rectal cancer has demonstrated noninferior clinical outcomes compared with conventional, long-course RT (LCRT), we investigate the environmental and health equity–related outcomes. METHODS AND MATERIALS: Patients treated with curative, preoperative RT for newly diagnosed rectal cancer at our institution between 2004 and 2022 and living in-state were included. Travel distance was estimated using patients’ reported home address. Associated GHG emissions were calculated and reported in carbon dioxide equivalents (CO(2)e). RESULTS: Of 334 patients included, the total distance traveled for the treatment course was significantly greater in patients treated with LCRT versus SCRT (median, 1417 vs 319 miles; P < .001). Total CO(2)e emissions for those undergoing LCRT (n = 261) and SCRT (n = 73) were 665.3 kg CO(2)e and 149.9 kg CO(2)e, respectively, per treatment course (P < .001), with a net difference of 515.4 kg CO(2)e. Relatively, this suggests that LCRT is associated with 4.5 times greater GHG emissions from patient transportation. CONCLUSIONS: Using treatment of rectal cancer as proof-of-principle, we advocate for the inclusion of environmental considerations in the creation of climate-resilient oncologic RT practices, especially in the context of equivocal clinical outcomes between RT fractionation schedules.