S1370
Interdisciplinary - Global health
ESTRO 2026
1 Radiation Oncology, University of Louisville, Louisville, USA. 2 Radiation Oncology, Korle-Bu Radiotherapy Centre, Accra, Ghana. 3 HSC - Bioinformatics & Biostatistics, University of Louisville, Louisville, USA. 4 Radiation Oncology, Dartmouth Hitchcock Medical Center Norris Cancer Center, Lebanon, USA. 5 Radiation Oncology, Brigham and Women's Hospital, Boston, USA. 6 Radiation Oncology, University of Oklahoma College of Medicine Stephenson Cancer Center, Oklahoma City, USA. 7 Radiation Oncology, Cape Breton Cancer Center, Sydney, Canada. 8 Radiation Oncology, City Cancer Challenge, Genève, Switzerland. 9 Radiation Oncology, MD Anderson Cancer Center, Houston, USA. 10 Radiation Oncology, University of Pennsylvania, Philadelphia, USA Purpose/Objective: Africa contributes little to GHGe but faces severe climate impacts. Climate change worsens health inequities, disrupts care, and raises cancer rates. ¹ ⁻ ⁴ As radiotherapy demand grows, its environmental impact must be assessed. This study quantifies radiotherapy’s carbon footprint in Ghana and compares it to US data. ⁵ ⁻ ⁷ Material/Methods: A retrospective, multi-institutional life cycle assessment (LCA) was conducted at two of Ghana’s three radiotherapy centers: Korle-Bu Teaching Hospital (KBTH) in Accra and the Swedish Ghana Medical Centre (SGMC) in East Legon. The LCA followed the methodology described by Lichter et al ¹⁸ and adhered to ISO 14040 and 14044 standards. ¹⁹ The system boundaries encompassed all stages of curative external beam radiotherapy (EBRT), from initial consultation to final treatment fraction. This included CT simulation, treatment planning and delivery, on- treatment reviews, use of reusable and disposable materials, clinic energy consumption, and transportation of patients and staff. Data were extracted from electronic medical records and categorized by disease site and institution. Results:
SGMC:Patients with gynecologic cancers traveled the longest distances (median 213.0 km), contributing 502.5 kgCO ₂ (63.3% of total patient emissions). In contrast, patients with gastrointestinal malignancies traveled a median of 33.7 km, contributing 151.2 kgCO ₂ (33.9%). Total emissions from patient travel were 25,364.78 kgCO ₂ , making it the largest contributor to overall emissions.Annual electricity consumption was measured over one year, averaged monthly, and scaled to a 58-month observation period. Assuming 61% solar and 39% hydropower usage, with a hydroelectric emission factor of 28 g CO ₂ e/kWh19, energy-related emissions totaled 15,972.63 kgCO ₂ .Other contributors included SF ₆ emissions (0.68 kgCO ₂ ) and staff travel (4,714.85 kgCO ₂ ).KBTH:Data from January 11, 2022, to October 29, 2024, showed staff travel as the highest emission source (3,731.76 kgCO ₂ ), followed by patient travel (1,435.8 kgCO ₂ ).Among disease sites, gastrointestinal malignancies had the highest emissions (103.9 kgCO ₂ ), while hematologic malignancies had the lowest (34.48 kgCO ₂ ).Cobalt-based treatments contributed 124.6 kgCO ₂ , compared to 20.9 kgCO ₂ from the peer review phase.Comparison with previously published data from the US and UK confirms that transportation and energy use are the primary contributors to radiotherapy-related GHGe. Conclusion: The first comprehensive LCA of radiotherapy delivery in Africa shows transport and energy as key emission sources. Ghana’s transport emissions exceeded those in high-income countries such as the US and the UK, likely due to infrastructure and vehicle differences. Findings underscore the need for tailored strategies to reduce the environmental impact of cancer care in low- and middle-income countries. References: Watts N, et al. Lancet. 2017;391:581–630.Ebi KL, et al. Lancet. 2021;398:875–877.Salas RN, et al. CA Cancer J Clin. 2021;71:91–93.Lichter AS, et al. Int J Radiat Oncol. 2022;112:e1–e6.WHO. Climate change and health. https://www.who.intIPCC. Climate Change 2022.Int Hydropower Assoc. https://www.hydropower.orgISO 14040:2006.ISO 14044:2006.Jemal A, et al. CA Cancer J Clin. 2011;61:69–90.Bray F, et al. CA Cancer J Clin. 2018;68:394–424.Atun R, et al. Lancet Oncol. 2015;16:1153–1186.Hanna TP, et al. Nat Rev Clin Oncol. 2020;17:268–270. Keywords: Ghana, Life cycle assessment, carbon footprint
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