At the Lichter GreenHealth Lab, we are reimagining the future of cancer care—one that protects both patient health and planetary health. Started at UCSF, now based at Dartmouth Cancer Center, our work focuses on understanding and reducing the environmental impact of cancer care delivery while building resilience in the face of climate change.
We use the cancer care continuum—especially breast cancer care—as a model to identify actionable opportunities for climate mitigation and adaptation that can be translated across oncology and broader healthcare systems.
Why Cancer Care?
Cancer centers are uniquely positioned to lead in sustainable healthcare transformation. They encompass nearly every component of modern healthcare—from imaging to surgery to systemic therapy—and serve patients who often engage longitudinally with the system. By focusing on oncology, we can model scalable, system-wide solutions that align environmental sustainability with high-quality, patient-centered care.
Our research falls into three interconnected focus areas:
Climate Change & Cancer Outcomes
We study how climate-related environmental exposures—such as wildfires, air pollution, and flooding—affect cancer development, treatment disruptions, and outcomes.
Key projects include:
- Wildfires and Cancer Care Disruption: Multi-site analysis of patient access and radiotherapy compliance during wildfire events in the U.S.
- Upper Valley Climate-Health Risk Mapping: Exploring links between regional environmental exposures and cancer burden in New Hampshire and Vermont.
- Climate Resilience in Oncology: Developing tools to strengthen system-level resilience to climate disruptions in cancer care delivery.
Click to show 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.
Environmental Impacts of Cancer Care Delivery
We identify and quantify the environmental 'footprint' of health systems & cancer care across the clinical pathway—from screening and diagnosis through treatment and survivorship.
Key projects include:
- Life Cycle Assessment (LCA) of Radiation Therapy: A national analysis of the carbon footprint of radiotherapy, including hypofractionation and system-level levers for decarbonization.
- Energy and Emissions in Imaging: Assessing the energy use and carbon intensity of breast cancer imaging (e.g., MRI, mammography) in partnership with radiology collaborators.
- Plastic Waste in Oncology: A systematic review of medical plastic use across cancer care, focused on identifying high-impact, low-cost alternatives.
Click to show 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
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
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.
Pathways to Action: Tools for Sustainable, Resilient Care
We are creating actionable tools and metrics to support decarbonization and resilience efforts across cancer centers, starting with Dartmouth and scalable to national models.
Current initiatives:
- SUSTAIN (Sustainable Transformation in Breast Imaging and Radiology): A pilot project to integrate environmental metrics into breast imaging decisions, with future applications in screening policy and reimbursement models.
- Scoping Review of the Cancer Care Pathway: Mapping high-impact intervention points for sustainability across the cancer care continuum, from diagnostics to survivorship.
- Development of Nomogram-Based Tools: Visual and data-driven decision tools to integrate environmental impact alongside quality and cost metrics in cancer care delivery.
Click to show 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.
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