Ecologic Imprint and Taxi Costs Associated with Different Fractionation Schedules for Prostate Cancer Radiotherapy: an Exemplary Calculation from Thuringia, That Makes You Think …

Abstract Background In times of climate change, energy transition, an aging population and skyrocketing social costs, improving the sustainability and cost-effectiveness of healthcare systems has become increasingly relevant. We evaluated three internationally established fractionation schedules for prostate cancer radiation therapy (RT) with respect to their ecological and health-economic impacts.Methods We analyzed the data of 109 patients with prostate cancer, who underwent outpatient radiation therapy at Jena University Hospital in 2022. Using the distance between their homes and our facility, carbon dioxide (CO2)-emissions and taxi costs were estimated for normofractionated RT (39 fractions), moderately hypofractionated RT (20 fractions) and ultrahypofractionated RT (5 fractions).Results Travel distances of 1616 km, 848 km and 242 km were calculated with corresponding costs ranging from 638 € (ultrahypofractionated RT) to 4255 € (normofractionated RT). The travel distance, CO2-emissions and transportation costs could be reduced by up to 85% by hypofractionation.Conclusion (Ultra-)hypofractionated radiation therapy for prostate cancer has great potential to protect the environment and lower healthcare costs. From this point of view, it should be regarded as new standard of care. However, the new short-term concepts place high demands on the accuracy of dose application which causes increased (technical and personnel) effort. To facilitate general use, adequate pricing structures and reimbursement mechanisms need to be established in the German health care system, ensuring equitable access to this innovative treatment option for all eligible patients.