{"id":6,"date":"2025-06-20T18:47:49","date_gmt":"2025-06-20T18:47:49","guid":{"rendered":"https:\/\/geiselmed.dartmouth.edu\/lichter-lab\/?page_id=6"},"modified":"2025-11-03T23:06:39","modified_gmt":"2025-11-03T23:06:39","slug":"research","status":"publish","type":"page","link":"https:\/\/geiselmed.dartmouth.edu\/lichter-lab\/our-work\/research\/","title":{"rendered":"Research"},"content":{"rendered":"<p data-start=\"417\" data-end=\"732\">At the Lichter GreenHealth Lab, we are reimagining the future of cancer care\u2014one 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.<\/p>\n<p data-start=\"734\" data-end=\"957\">We use\u00a0<strong data-start=\"741\" data-end=\"811\">the cancer care continuum\u2014especially breast cancer care\u2014as a model<\/strong>\u00a0to identify actionable opportunities for climate mitigation and adaptation that can be translated across oncology and broader healthcare systems.<\/p>\n<h3 data-start=\"3335\" data-end=\"3355\">Why Cancer Care?<\/h3>\n<p data-start=\"3357\" data-end=\"3772\">Cancer centers are uniquely positioned to lead in sustainable healthcare transformation. They encompass nearly every component of modern healthcare\u2014from imaging to surgery to systemic therapy\u2014and serve patients who often engage longitudinally with the system. By focusing on oncology, we can model scalable, system-wide solutions that align\u00a0<strong data-start=\"3698\" data-end=\"3772\">environmental sustainability with high-quality, patient-centered care.<\/strong><\/p>\n<p data-start=\"959\" data-end=\"1016\">Our research falls into three interconnected focus areas:<\/p>\n<div style=\"background-color: #00693e;color: #ffffff;padding: 20px\">\n<hr \/>\n<h4 style=\"font-weight: 300\"><span style=\"color: #ffffff;font-size: 24pt\"><strong style=\"font-style: inherit;font-weight: 600\">Climate Change &amp; Cancer Outcomes<\/strong><\/span><\/h4>\n<hr \/>\n<p style=\"font-weight: 400\">We study how climate-related environmental exposures\u2014such as wildfires, air pollution, and flooding\u2014affect cancer development, treatment disruptions, and outcomes.<\/p>\n<p style=\"font-weight: 400\" data-start=\"2008\" data-end=\"2033\"><strong style=\"font-style: inherit;font-weight: 600\" data-start=\"2008\" data-end=\"2033\">Key projects include:<\/strong><\/p>\n<ul style=\"font-weight: 400\" data-start=\"2034\" data-end=\"2472\">\n<li data-start=\"2034\" data-end=\"2178\"><strong style=\"font-style: inherit;font-weight: 600\" data-start=\"2036\" data-end=\"2077\">Wildfires and Cancer Care Disruption:<\/strong>\u00a0Multi-site analysis of patient access and radiotherapy compliance during wildfire events in the U.S.<\/li>\n<li data-start=\"2179\" data-end=\"2331\"><strong style=\"font-style: inherit;font-weight: 600\" data-start=\"2181\" data-end=\"2226\">Upper Valley Climate-Health Risk Mapping:<\/strong>\u00a0Exploring links between regional environmental exposures and cancer burden in New Hampshire and Vermont.<\/li>\n<li data-start=\"2332\" data-end=\"2472\"><strong style=\"font-style: inherit;font-weight: 600\" data-start=\"2334\" data-end=\"2369\">Climate Resilience in Oncology:<\/strong>\u00a0Developing tools to strengthen system-level resilience to climate disruptions in cancer care delivery.<\/li>\n<\/ul>\n<\/div>\n<details id=\"selected-work\" class=\"accordion-item ck-widget\">\n<summary style=\"color: #008000;font-size: 14pt\">Click to show Selected Work<\/summary>\n<p class=\"content-text\">Houghton A, Bole A, Lichter KE, Balbus JM.\u00a0<a href=\"https:\/\/medsocietiesforclimatehealth.org\/wp-content\/uploads\/2025\/01\/CR4HC_Toolkit_Final_12.20.2024.pdf\">Climate Resilience for Health Care Toolkit.<\/a>\u00a0Published online January 2025.<\/p>\n<p class=\"content-text\">Lichter KE, Larson B, Pagadala M, Mohamad O, et al.\u00a0<a href=\"https:\/\/link.springer.com\/article\/10.1007\/s10552-024-01949-2\">Impact of declared wildfire disasters on survival of lung cancer patients undergoing radiation<\/a>. Cancer Causes Control. 2025. doi:\u00a0<a href=\"https:\/\/doi.org\/10.1007\/s10552-024-01949-2\">10.1007\/s10552-024-01949-2<\/a><\/p>\n<p class=\"content-text\">Drew T, Conway A, Do I, et al.\u00a0<a href=\"https:\/\/drive.google.com\/file\/d\/1JJXv9zozQr61kCn5G-AKu0NxVG0rCjPe\/view?usp=sharing\">Impact of extreme climate events on Puerto Rican radiation oncology practices.<\/a>\u00a0UCSF La Comunidad Conference, San Francisco, CA, April 2025.<\/p>\n<p class=\"content-text\">Lichter K, Sabol R, Yom SS, Mohamad O, Witztum A.<a href=\"https:\/\/ascopubs.org\/doi\/10.1200\/JCO.2024.42.16_suppl.e23154\">\u00a0Impact of wildfires on radiotherapy adherence in patients with cancer: A multi-clinic study<\/a>. JCO. 2024;42(16_suppl):e23154-e23154.<\/p>\n<p>Lichter KE, Baniel CC, Do I, et al.\u00a0<a href=\"http:\/\/doi.org\/10.1016\/j.adro.2023.101395\">Impacts of wildfire events on California radiation oncology clinics and patients<\/a>. Advances in Radiation Oncology. Published online October 22, 2023:101395.<\/p>\n<\/details>\n<p>&nbsp;<\/p>\n<div style=\"background-color: #00693e;color: #ffffff;padding: 20px\">\n<hr \/>\n<h4 style=\"font-weight: 300\"><span style=\"color: #ffffff;font-size: 24pt\"><strong style=\"font-style: inherit;font-weight: 600\">Environmental Impacts of Cancer Care Delivery<\/strong><\/span><\/h4>\n<hr \/>\n<p style=\"font-weight: 400\" data-start=\"1080\" data-end=\"1240\">We identify and quantify the environmental 'footprint' of health systems &amp; cancer care\u00a0<u>across the clinical pathway<\/u>\u2014from screening and diagnosis through treatment and survivorship.<\/p>\n<p style=\"font-weight: 400\" data-start=\"1242\" data-end=\"1267\"><strong style=\"font-style: inherit;font-weight: 600\" data-start=\"1242\" data-end=\"1267\">Key projects include:<\/strong><\/p>\n<ul style=\"font-weight: 400\" data-start=\"1268\" data-end=\"1792\">\n<li data-start=\"1268\" data-end=\"1457\"><strong style=\"font-style: inherit;font-weight: 600\" data-start=\"1270\" data-end=\"1323\">Life Cycle Assessment (LCA) of Radiation Therapy:<\/strong>\u00a0A national analysis of the carbon footprint of radiotherapy, including hypofractionation and system-level levers for decarbonization.<\/li>\n<li data-start=\"1458\" data-end=\"1637\"><strong style=\"font-style: inherit;font-weight: 600\" data-start=\"1460\" data-end=\"1496\">Energy and Emissions in Imaging:<\/strong>\u00a0Assessing the energy use and carbon intensity of breast cancer imaging (e.g., MRI, mammography) in partnership with radiology collaborators.<\/li>\n<li data-start=\"1638\" data-end=\"1792\"><strong style=\"font-style: inherit;font-weight: 600\" data-start=\"1640\" data-end=\"1670\">Plastic Waste in Oncology:<\/strong>\u00a0A systematic review of medical plastic use across cancer care, focused on identifying high-impact, low-cost alternatives.<\/li>\n<\/ul>\n<\/div>\n<details id=\"selected-work\" class=\"accordion-item ck-widget\">\n<summary style=\"color: #008000;font-size: 14pt\">Click to show Selected Work<\/summary>\n<p class=\"content-text\">Lichter KE, Charbonneau K, Lewy JR, et al.\u00a0<a href=\"https:\/\/www.sciencedirect.com\/science\/article\/pii\/S1470204524001487\">Quantification of the environmental impact of radiotherapy and associated secondary human health effects: a multi-institutional retrospective analysis and simulation<\/a>. The Lancet Oncology. 2024;25(6):790-801.\u00a0<a href=\"https:\/\/www.sciencedirect.com\/science\/article\/pii\/S1470204524001487\">doi:10.1016\/S1470-2045(24)00148-7<\/a><\/p>\n<p class=\"content-text\">Asaro A, Charbonneau K, Anand C, Thiel C, Truong MT, Parekh A, Qureshi MM, Mohamad O, Lichter KE.\u00a0<a href=\"https:\/\/docs.google.com\/presentation\/d\/e\/2PACX-1vQ26rFB9iTthyGnx8Q57oGDIbTmm2zZEcwLveCq2oOQADf4tvAjXIp17ZAK70IegA\/pub?start=false&amp;loop=false&amp;delayms=3000\">Climate-smart oncology: Can hypofractionation lighten radiotherapy's environmental load?\u00a0<\/a>ASTRO\u00a0Annual Meeting, Palm Springs, CA, May 2024.<\/p>\n<p class=\"content-text\">Bhatia RK, Lichter KE, Zaorsky NG, Mantz C.\u00a0<a href=\"https:\/\/doi.org\/10.1136\/bmj-2023-079072\">Using hypofractionation to decarbonise radiation oncology<\/a>.\u00a0<em>BMJ<\/em>. 2024;386:e079072. doi:<a href=\"https:\/\/doi.org\/10.1136\/bmj-2023-079072\">10.1136\/bmj-2023-079072<\/a><\/p>\n<p class=\"content-text\">Lichter KE, Charbonneau K, Sabbagh A, et al. Evaluating the\u00a0<a href=\"https:\/\/www.sciencedirect.com\/science\/article\/abs\/pii\/S0360301623004406?via%3Dihub\">Environmental empact of radiotherapy using life cycle assessments: A critical review.<\/a>\u00a0International Journal of Radiation Oncology, Biology, Physics. 2023;0(0). doi:<a href=\"https:\/\/doi.org\/10.1016\/j.ijrobp.2023.04.036\">10.1016\/j.ijrobp.2023.04.036<\/a><\/p>\n<p class=\"content-text\">Abel A, McCannon J, Boyden H, et al. Emissions Disclosures and Energy Use Reporting by Hospitals in the United States.\u00a0<em>NAM Perspect<\/em>. 2024;2024. doi:<a href=\"https:\/\/doi.org\/10.31478\/202411c\">10.31478\/202411c<\/a><\/p>\n<p class=\"content-text\">Smolen KA, Luu J, Braunstein SE, et al.\u00a0<a href=\"https:\/\/www.sciencedirect.com\/science\/article\/pii\/S2667278223000962\">Shifting Gears to Green: A Pilot Study on Decarbonizing Patient Transport.<\/a>\u00a0The Journal of Climate Change and Health. Published online December 24, 2023:100297.\u00a0<a href=\"https:\/\/www.sciencedirect.com\/science\/article\/pii\/S2667278223000962\">doi:10.1016\/j.joclim.2023.100297<\/a><\/p>\n<p>Lichter KE, Bloom JR, Sheu RD, et al.\u00a0<a href=\"https:\/\/www.practicalradonc.org\/article\/S1879-8500(23)00174-1\/fulltext?fbclid=IwAR32QFxJTtz_PO2C4ckccW_rSECa1QsLFbAU8YvoYHiqj0KaNOrc8qmtYL8\">Tracking and Reducing SF6 Usage in Radiation Oncology: A Step Toward Net-Zero Health Care Emissions<\/a>. Practical Radiation Oncology. 2023;0(0). doi:<a href=\"https:\/\/doi.org\/10.1016\/j.prro.2023.06.003\">10.1016\/j.prro.2023.06.003<\/a><\/p>\n<p>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.\u00a0<a href=\"https:\/\/www.sciencedirect.com\/science\/article\/pii\/S1538472122000897?via%3Dihub\">Environmentally sustainable brachytherapy care.<\/a>\u00a0Brachytherapy. 2022 Jul 3;. doi: 10.1016\/j.brachy.2022.06.002. PubMed PMID: 35794032.<\/p>\n<p>Lichter KE, Drew T, Demeulenaere S, Wong E, Mohamad O, Yom SS, Bagshaw HP.\u00a0<a href=\"https:\/\/jamanetwork.com\/journals\/jamaoncology\/fullarticle\/2793716\">Environmental Outcomes Associated With Transition From In-Person to a Virtual Oncology Conference During the COVID-19 Pandemic.\u00a0<\/a>JAMA Oncol. 2022 Jun 23;.\u00a0<a href=\"https:\/\/jamanetwork.com\/journals\/jamaoncology\/fullarticle\/2793716\">doi: 10.1001\/jamaoncol.2022.1925<\/a>. PubMed PMID: 35737362.<\/p>\n<\/details>\n<p>&nbsp;<\/p>\n<div style=\"background-color: #00693e;color: #ffffff;padding: 20px\">\n<hr \/>\n<h4 style=\"font-weight: 300\"><span style=\"font-size: 24pt;color: #ffffff\"><strong style=\"font-style: inherit;font-weight: 600\">Pathways to Action: Tools for Sustainable, Resilient Care<\/strong><\/span><\/h4>\n<hr \/>\n<p style=\"font-weight: 400\" data-start=\"2548\" data-end=\"2722\">We are creating actionable tools and metrics to support decarbonization and resilience efforts across cancer centers, starting with Dartmouth and scalable to national models.<\/p>\n<p style=\"font-weight: 400\" data-start=\"2724\" data-end=\"2748\"><strong style=\"font-style: inherit;font-weight: 600\" data-start=\"2724\" data-end=\"2748\">Current initiatives:<\/strong><\/p>\n<ul style=\"font-weight: 400\" data-start=\"2749\" data-end=\"3328\">\n<li data-start=\"2749\" data-end=\"2977\"><strong style=\"font-style: inherit;font-weight: 600\" data-start=\"2751\" data-end=\"2824\">SUSTAIN (Sustainable Transformation in Breast Imaging and Radiology):<\/strong>\u00a0A pilot project to integrate environmental metrics into breast imaging decisions, with future applications in screening policy and reimbursement models.<\/li>\n<li data-start=\"2978\" data-end=\"3153\"><strong style=\"font-style: inherit;font-weight: 600\" data-start=\"2980\" data-end=\"3026\">Scoping Review of the Cancer Care Pathway:<\/strong>\u00a0Mapping high-impact intervention points for sustainability across the cancer care continuum, from diagnostics to survivorship.<\/li>\n<li data-start=\"3154\" data-end=\"3328\"><strong style=\"font-style: inherit;font-weight: 600\" data-start=\"3156\" data-end=\"3196\">Development of Nomogram-Based Tools:<\/strong>\u00a0Visual and data-driven decision tools to integrate environmental impact alongside quality and cost metrics in cancer care delivery.<\/li>\n<\/ul>\n<\/div>\n<details id=\"selected-work\" class=\"accordion-item ck-widget\">\n<summary style=\"color: #008000;font-size: 14pt\">Click to show Selected Work<\/summary>\n<p class=\"content-text\">Baniel CC, Lichter KE, Frick MA, Wu J, et al.\u00a0<a href=\"https:\/\/www.sciencedirect.com\/science\/article\/pii\/S1538472125000133\">The NorCal brachytherapy waste audit: A simple, validated, toolkit for clinician led waste reduction.<\/a>\u00a0Brachytherapy. 2025. doi:\u00a0<a href=\"https:\/\/doi.org\/10.1016\/j.brachy.2025.01.002\">10.1016\/j.brachy.2025.01.002<\/a><\/p>\n<article><\/article>\n<p class=\"content-text\">Lichter KE, Phuong C, Liu J, Ni L, Smith A, Shin J, Braunstein S, Hsu I, Prionas N, Mohamad O.\u00a0<a href=\"https:\/\/docs.google.com\/presentation\/d\/e\/2PACX-1vQs5wI3GGMK-TePOslSgK04JE_vXekD6RqvE0QTHq8hLZGiPcan3s8pyrArDWMOBsHWBeP9QATwm8s5\/pub?start=false&amp;loop=false&amp;delayms=3000\">Streamlining brachytherapy OR waste management in 60 seconds: The AI solution<\/a>. American Brachytherapy Society, June 2023.<\/p>\n<article><\/article>\n<p class=\"content-text\">Baniel C, KE Lichter.\u00a0<a href=\"https:\/\/docs.google.com\/presentation\/d\/e\/2PACX-1vSacdi0VY8Kdgnfqv9LlPp7WNy8dQWzAZvLCgvtEddLHH4AlZP6LkN4ppqTYnQH6sHFHiHp_0QDdSXo\/pub?start=false&amp;loop=false&amp;delayms=3000\">A six minute waste audit: A resident-led QI initiative to reduce medical waste.<\/a>\u00a0Norcal Symposium, September 2022.<\/p>\n<article><\/article>\n<p class=\"content-text\">Baniel CC, Sabol RA, Nieto R, et al. Green Horizons in Oncology: A Blueprint for Environmentally Sustainable Radiation Therapy Facilities.\u00a0<em>Seminars in Radiation Oncology<\/em>. 2024;34(4):426-432. doi:<a href=\"https:\/\/doi.org\/10.1016\/j.semradonc.2024.07.004\">10.1016\/j.semradonc.2024.07.004<\/a><\/p>\n<article><\/article>\n<p class=\"content-text\">Lichter KE, Sabbagh A, Demeulenaere S, et al.\u00a0<a href=\"https:\/\/ascopubs.org\/doi\/10.1200\/GO.23.00209\">Reducing the Environmental Impact of Health Care Conferences: A Study of Emissions and Practical Solutions. JCO Global Oncology<\/a>. Published online February 15, 2024. doi:10.1200\/GO.23.00209<\/p>\n<\/details>\n<p data-start=\"3357\" data-end=\"3772\">\n","protected":false},"excerpt":{"rendered":"<p>At the Lichter GreenHealth Lab, we are reimagining the future of cancer care\u2014one 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 [\u2026] <\/p>\n<div class=\"clear\"><\/div>\n<p><a class=\"more_link clearfix\" href=\"https:\/\/geiselmed.dartmouth.edu\/lichter-lab\/our-work\/research\/\" rel=\"nofollow\">Read More<\/a><\/p>\n","protected":false},"author":2,"featured_media":0,"parent":75,"menu_order":1,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-6","page","type-page","status-publish","hentry","author-2"],"_links":{"self":[{"href":"https:\/\/geiselmed.dartmouth.edu\/lichter-lab\/wp-json\/wp\/v2\/pages\/6","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/geiselmed.dartmouth.edu\/lichter-lab\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/geiselmed.dartmouth.edu\/lichter-lab\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/geiselmed.dartmouth.edu\/lichter-lab\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/geiselmed.dartmouth.edu\/lichter-lab\/wp-json\/wp\/v2\/comments?post=6"}],"version-history":[{"count":23,"href":"https:\/\/geiselmed.dartmouth.edu\/lichter-lab\/wp-json\/wp\/v2\/pages\/6\/revisions"}],"predecessor-version":[{"id":552,"href":"https:\/\/geiselmed.dartmouth.edu\/lichter-lab\/wp-json\/wp\/v2\/pages\/6\/revisions\/552"}],"up":[{"embeddable":true,"href":"https:\/\/geiselmed.dartmouth.edu\/lichter-lab\/wp-json\/wp\/v2\/pages\/75"}],"wp:attachment":[{"href":"https:\/\/geiselmed.dartmouth.edu\/lichter-lab\/wp-json\/wp\/v2\/media?parent=6"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}