The GreenHealth lab at UCSF studies the interplay between healthcare delivery and climate change, especially in the context of cancer care. We explore the impact of the healthcare sector and health institutions on the environment, and the impact of climate change on clinical care. Our findings help shape mitigation and adaptation efforts, improving hospital sustainability and creating more climate-resilient systems.
OUR RESEARCH AREAS
Impacts of Climate Change on Cancer Care
Climate-fueled events and disasters, particularly wildfires, are a focus area for our California-based lab. As wildfires have increased in frequency and intensity, cancer patients under treatment are at increased risk of interruptions in essential care. Our research seeks to understand these impacts on patients, especially those undergoing radiotherapy treatment.
Selected Work
Houghton, A, Bole A, Lichter KE, Balbus JM. Climate Resilience for Health Care Toolkit. Published online January 2025.
Lichter KE, Larson B, Pagadala M, Mohamad O, et al. Impact of declared wildfire disasters on survival of lung cancer patients undergoing radiation. Cancer Causes Control. 2025. doi: 10.1007/s10552-024-01949-2
Drew T, Conway A, Do I, et al. Impact of extreme climate events on Puerto Rican radiation oncology practices. UCSF La Comunidad Conference, San Francisco, CA, April 2025.
Lichter K, Sabol R, Yom SS, Mohamad O, Witztum A. Impact of wildfires on radiotherapy adherence in patients with cancer: A multi-clinic study. JCO. 2024;42(16_suppl):e23154-e23154.
Lichter KE, Baniel CC, Do I, et al. Impacts of wildfire events on California radiation oncology clinics and patients. Advances in Radiation Oncology. Published online October 22, 2023:101395.
Life Cycle Assessment of Healthcare Processes
GreenHealth Lab is committed to promoting the use of life cycle assessment (LCA) methodology to rigorously understand the multidimensional environmental impact of healthcare processes and inform policy updates. We have published a methodology for LCA in electron beam radiation therapy and applied it to characterize the impacts of this treatment modality across multiple institutions, identifying levers for reducing environmental impact.
Selected Work
Lichter KE, Charbonneau K, Lewy JR, et al. Quantification of the environmental impact of radiotherapy and associated secondary human health effects: a multi-institutional retrospective analysis and simulation. The Lancet Oncology. 2024;25(6):790-801. doi:10.1016/S1470-2045(24)00148-7
Asaro A, Charbonneau K, Anand C, Thiel C, Truong MT, Parekh A, Qureshi MM, Mohamad O, Lichter KE. Climate-smart oncology: Can hypofractionation lighten radiotherapy's environmental load? ASTRO Annual Meeting, Palm Springs, CA, May 2024.
Bhatia RK, Lichter KE, Zaorsky NG, Mantz C. Using hypofractionation to decarbonise radiation oncology. BMJ. 2024;386:e079072. doi:10.1136/bmj-2023-079072
Lichter KE, Charbonneau K, Sabbagh A, et al. Evaluating the Environmental empact of radiotherapy using life cycle assessments: A critical review. International Journal of Radiation Oncology, Biology, Physics. 2023;0(0). doi:10.1016/j.ijrobp.2023.04.036
Decarbonization Advocacy Across Cancer Care
The lab contributes to efforts to reduce the environmental footprint of cancer care, including patient travel & virtual care, faculty travel to professional conferences, clinical trial development, and the environmental impact of specific procedures. In service of reducing emissions from conference travel, we developed the Network Greener Calculator to allow individuals or departments to estimate their emissions associated with traveling to or hosting a conference.
Selected Work
Abel A, McCannon J, Boyden H, et al. Emissions Disclosures and Energy Use Reporting by Hospitals in the United States. NAM Perspect. 2024;2024. doi:10.31478/202411c
Baniel CC, Sabol RA, Nieto R, et al. Green Horizons in Oncology: A Blueprint for Environmentally Sustainable Radiation Therapy Facilities. Seminars in Radiation Oncology. 2024;34(4):426-432. doi:10.1016/j.semradonc.2024.07.004
Lichter KE, Sabbagh A, Demeulenaere S, et al. Reducing the Environmental Impact of Health Care Conferences: A Study of Emissions and Practical Solutions. JCO Global Oncology. Published online February 15, 2024. doi:10.1200/GO.23.00209
Smolen KA, Luu J, Braunstein SE, et al. Shifting Gears to Green: A Pilot Study on Decarbonizing Patient Transport. The Journal of Climate Change and Health. Published online December 24, 2023:100297. doi:10.1016/j.joclim.2023.100297
Lichter KE, Bloom JR, Sheu RD, et al. Tracking and Reducing SF6 Usage in Radiation Oncology: A Step Toward Net-Zero Health Care Emissions. Practical Radiation Oncology. 2023;0(0). doi:10.1016/j.prro.2023.06.003
Lichter KE, Baniel CC, Anderson J, Bhatia R, Frick MA, Thiel CL, Gandhi S, Sarria GR, Bagshaw HP, Petereit D, Chino J, Grover S, Singer L, Hsu IC, Mohamad O. Environmentally sustainable brachytherapy care. Brachytherapy. 2022 Jul 3;. doi: 10.1016/j.brachy.2022.06.002. PubMed PMID: 35794032.
Lichter KE, Drew T, Demeulenaere S, Wong E, Mohamad O, Yom SS, Bagshaw HP. Environmental Outcomes Associated With Transition From In-Person to a Virtual Oncology Conference During the COVID-19 Pandemic. JAMA Oncol. 2022 Jun 23;. doi: 10.1001/jamaoncol.2022.1925. PubMed PMID: 35737362.
Healthcare Waste Reduction
Our work developing the Norcal Waste Audit Toolkit supports individuals seeking to complete a waste audit in a clinical setting. We have primarily focused on waste auditing and reduction in the context of brachytherapy procedures and are interested in exploring other dimensions of waste associated with the cancer control continuum.
Selected Work
Baniel CC, Lichter KE, Frick MA, Wu J, et al. The NorCal brachytherapy waste audit: A simple, validated, toolkit for clinician led waste reduction. Brachytherapy. 2025. doi: 10.1016/j.brachy.2025.01.002
Lichter KE, Phuong C, Liu J, Ni L, Smith A, Shin J, Braunstein S, Hsu I, Prionas N, Mohamad O. Streamlining brachytherapy OR waste management in 60 seconds: The AI solution. American Brachytherapy Society, June 2023.
Baniel C, KE Lichter. A six minute waste audit: A resident-led QI initiative to reduce medical waste. Norcal Symposium, September 2022.