Carbon footprint and staff demands of surgery and chemoradiation for muscle-invasive bladder cancer.

Objective: To calculate the environmental and labour impact of two complete care pathways for patients with muscle-invasive bladder cancer (MIBC) with similar oncological outcomes: radical cystectomy (RC) and chemoradiation (CRT), by quantifying the total carbon footprint and staff demands.

Patients and methods: The RC was robot-assisted surgery with pelvic lymph node dissection and ileal conduit. CRT included 20 fractions of 2/2.75 Gy with mitomycin C (Day 1) and capecitabine every radiation day. Waste audits identified medical products (n = 284), for which a cradle-to-gate environmental impact analysis was conducted from treatment selection to first post-treatment evaluation. Energy use was based on primary data, technical specifications or literature. Patient travel was based on the average distance, assuming petrol-fuelled cars. Staff demands were assessed by timing clinical staff assignment. The carbon footprint was calculated in CO₂-equivalents using the Ecoinvent Database 3.10.

Results: The carbon footprint was 208 kg CO₂-equivalents for RC vs 264 kg CO₂-equivalents for CRT. The larger footprint of CRT arose from travel movements and energy use: 5- and 1.5-fold higher than RC, respectively. Main contributors to the total footprint were medical products for RC (49%), and patient travel for CRT (74%). A hotspot analysis identified 10 medical products with the highest impact, which accounted for 60% of the total impact of all medical products. RC averaged 93.5 staff hours per patient vs 29.0 staff hours per patient for CRT.

Conclusions: This is the first study to analyse the environmental impact of complete care pathways in uro-oncology. Key strategies to reduce the carbon footprint of MIBC treatment include low-impact patient travel, reviewing high-impact surgical products, and using renewable energy by hospitals. Insight into staff demands per treatment assists efficient allocation of scarce personnel.