Preliminary Assessment of Travel-Related Accessibility for Breast and Prostate Cancer Radiotherapy Patients: A First Step Towards Life Cycle Assessment in Ghana

Summary: With rising cancer rates among minority populations and growing climate concerns, this study represents an initial step towards a comprehensive lifecycle assessment (LCA) of external beam radiotherapy (EBRT) in Ghana. Travel-related data for patients with breast or prostate cancer was collected as a foundational component of a future LCA, adapting recent findings from the U.S. to a global context. Using the ISO 14040 and 14044 standards as guide for data collection, this preliminary analysis focuses on breast or prostate cancer patients receiving EBRT at Korle-Bu Teaching Hospital (KBTH), Ghana from 2023-2024. Data included patient travel and staff travel (comprising the biostatistician, nurse, health assistant, and oncologist), serving as one component of a broader LCA across the entire treatment lifecycle. These travel patterns were compared to published United States (US) data. Final analysis included ten breast cancer patients (six received 50 Gy/25 fractions, four received 40.05 Gy/15 fractions) and ten prostate cancer patients (six received 78 Gy/39 fractions, two received 60 Gy/20 fractions, one a 40-fraction regimen, and another a 17-fraction regimen). Nine breast cancer patients were treated via a cobalt machine, and one was delivered via linac; all ten prostate cancer patients were treated with linac. For initial consultation, breast cancer patients traveled median 13.9 km (8.6 mi); median distance traveled by staff was 10.5 km (6.5 mi). During treatment, breast cancer patients traveled median 15.3 km (9.5 mi); radiation therapists traveled a median of 11.8 km (7.3 mi). Prostate cancer patients traveled median 11.9 km (7.4 mi) for consultations; staff had median travel distance of 10.5 km (6.5 mi). During treatment, prostate cancer patients traveled median 15.1 km (9.4 mi); radiation therapists traveled a median of 31.9 km (19.8 mi). Compared with published US data, the median travel distance for KBTH breast cancer patients (18.1 mi) was longer than those at UCSF (4.8 mi) and Mount Sinai (5.7 mi) but shorter than at Duke (81 mi) and UMichigan (19.9 mi). Prostate cancer patients at KBTH had a shorter median travel distance (16.8 mi) compared to Duke (120.5 mi) and UMichigan (40.4 mi) but longer than Mount Sinai (8.4 mi) and UCSF (12.5 mi). Most KBTH staff traveled by public transit compared with car for US counterparts. These findings highlight the feasibility of conducting LCAs in Ghana and provide insights into patient and staff travel patterns compared to US benchmarks. As travel is only one aspect of a full LCA, work including additional EBRT-associated environmental impacts to provide a comprehensive view of the environmental footprint of radiotherapy in Ghana is ongoing. Phylicia Gawu (she/her/hers), phyliciaodume@gmail.com (Presenting Author) - University of Oklahoma Health Sciences Center; Charles Akoto-Aidoo, BSc (Co-Author) - Korle-Bu Teaching Hospital; Isaac Washburn, PhD (Co-Author) - University of Oklahoma; Idalid Franco, MD, MPH (Co-Author) - Brigham and Women's Hospital/Dana-Farber Brigham Cancer Center; Jerry Jaboin, MD, PhD, MBA, FACRO, FASTRO (Co-Author) - University of Oklahoma Health Sciences Center; Aba Scott, MBChB (Co-Author) - Cape Breton Cancer Centre; Meritxell Mallafre-Larrosa, MD MPH (Co-Author) - City Cancer Challenge.; Alfredo Polo, MD (Co-Author) - City Cancer Challenge; Osama Mohamad, M.D., Ph.D. (Co-Author) - MD Anderson Radiation Treatment Center; Surbhi Grover, MD, MPH (Co-Author) - Radiation Oncology at the Hospital of the University of Pennsylvania; Katie Lichter, MD, MPH (Co-Author) - UCSF Department of Radiation Oncology; Verna Vanderpuye, MBChB, FASCO (Co-Author) - Korle-Bu Teaching Hospital; Shearwood McClelland, MD (Co-Author) - University Hospitals Seidman Cancer Center Case Western Reserve University School of Medicine