## Balancing Sustainability and Healthcare Demands in Bladder Cancer Treatment
A recent study from Erasmus MC, published online ahead of print in *BJU International* (Rutten VC, Hesseling SA, Franckena M, et al.), investigated teh environmental and personnel impacts of two common treatments for muscle-invasive bladder cancer: surgery and chemoradiation. The research was motivated by Erasmus MC’s new sustainability strategy and the current challenges of healthcare staff shortages.
researchers, including PhD student Vera Rutten and Prof. Dr. Joost Boormans, aimed to quantify the “ecological footprint” of each treatment option, focusing on factors within the hospital’s control – materials, equipment, electricity consumption, and staff deployment – throughout the entire patient care pathway. The study deliberately excluded factors outside the hospital walls to ensure relevance for hospital policymakers.
A key finding highlighted the meaningful influence of patient travel distance on the overall environmental impact. The research identified a 15-kilometer threshold: for patients living closer than 15km, chemoradiation demonstrated a lower ecological footprint, while surgery was preferable for those traveling further. This suggests potential for optimizing treatment selection based on geographical factors. The study acknowledges that the majority of patients travel to the hospital by car, based on data from Erasmus MC and consistent with other research.
The study also noted the decreasing impact of radiotherapy travel due to advancements in treatment schedules. Prostate cancer radiotherapy has been reduced from 39 to 7 fractions,and bladder cancer treatment now utilizes 20 fractions instead of 33. Further shortening these schedules could yield substantial reductions in the CO2 footprint.
Regarding personnel demands, the researchers found that Erasmus MC’s status as a teaching hospital – with students and doctors in training involved in procedures – increased the number of staff involved. Though, Rutten expressed doubt about further reducing staff deployment, noting that current bedside time may already be minimal. A significant driver of personnel needs is the 7-day hospital stay required after surgery.
Boormans and Rutten emphasize that this study represents a crucial first step in understanding the complex interplay between healthcare delivery, environmental sustainability, and resource allocation within uro-oncological care. They are currently initiating a similar study focusing on prostate cancer treatment, with results expected in the spring.The researchers hope their findings will inform future treatment decisions and contribute to a more lasting healthcare system.
